UMAT Section 2

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Tertiary Prep Skills© 2002-2004

UMAT SUPERPREP COURSES

PRE-COURSE STUDY MATERIALS

PART 2

INTERPERSONAL COMMUNICATION



CONTENTS GENERAL INTRODUCTION SECTION 1: PERSONAL DEVELOPMENT

Empathy Honesty

SECTION 2: COMMUNICATION SKILLS Conflict Resolution Appropriate Communication SECTION 3: PROFESSIONAL DEVELOPMENT

Professional Conduct Prioritising Skills TIMED TRIAL TESTS........... SECTION 1: PERSONAL DEVELOPMENT Empathy Answers Honesty Answers SECTION 2: COMMUNICATION SKILLS Conflict Resolution Answers Appropriate Communication Answers SECTION 3: PROFESSIONAL DEVELOPMENT Professional Conduct Answers Prioritising Skills Answers General introduction:



The purpose of this book is to provide a structured preparation for all Health Professionals wishing to review or learn initially, interpersonal skills essential to the practice of their occupation.The topic of Interpersonal Skills has been divided into three main sections dealing with the three important recurring aspects of interpersonal communication:

Personal development Communication skills Professional development

The first section deals with qualities. These are attitudes that people have towards other people that are engendered from a young age. However, the principles surrounding many personal qualities can be taught, and through the process of education and personal development, certain qualities can be fostered. The latter two sections are about skills. These are different in that they are less likely to be innate and have to be taught. Most people will have some basic proficiency at communication skills and professional conduct, as these are skills we use on a day to day basis. In a profession such as medicine, it has been necessary to foster and teach these in a specific context, as there are ethical and legal ramifications attached to our behaviour when we interact with people in a professional context. Each section has been divided into two categories as follows:

Section 1: Personal development

Section2: Communication skills Section3: Professional development

Qualities:

Skills: Skills:

1.1 Empathy 2.1 Conflict resolution

3.1 Professional conduct

1.2 Honesty

2.2 Appropriate communication 3.2 Prioritising skills

Section 1: PERSONAL DEVELOPMENT: 1.1 Empathy: What is empathy? Empathy may be defined as the ability to accurately perceive the feelings of another person and to communicate this understanding to that person. Empathy is important in any healthcare setting as it allows the healthcare professional to understand the patient’s needs and also deepens the relationship between carer and patient. This ultimately results in better treatment of the patient and better patient compliance with that treatment. There are several general guidelines for developing empathic understanding. The most important are:

Listening: Empathy can perhaps best be achieved through the process of carefully listening and attending to the other person. The ear is often as important as the eye in medical practice and other healthcare professions.

Relating: This means understanding the problem from the patient’s point of view. (Health

care workers often learn the value of empathy when they themselves fall sick and can then relate to the feelings of other people who are ill.)



Reassuring: The ability to provide reassurance to another person is important. In a

medical setting, reassurance may often contain medical information, which should always be explained in such a way that the patient can understand it easily.

The Health Professional should be aware that many questions in the Interaction Skills section will examine basic attitudes toward patient empathy. The following examples all illustrate the principles of listening to the patient’s concerns, relating to their problem and then offering some form of reassurance or explanation. Example:1 Category: Empathy Scenario: You are a nurse looking after a teenage boy who is awaiting a major operation to remove a bone tumour near his knee. He is very anxious as he has never had an operation before and is worried that he may not be able to walk normally again. As you are preparing him for his operation, he starts crying. What do you do? Choices: a) You have other patients to prepare for their operations and hurriedly rush off and get on with your duties. b) You sit down with him for as long as you can, listen to his concerns, and try to reassure him that he will most probably make a good recovery and will be able to walk again given time. c) You tell him not to be silly and that he is old enough to be brave and handle the situation. d) You sternly tell him to pull himself together and that if he does not have the operation the tumour might kill him. e) You quietly leave his room so that neither of you will be embarrassed. Answer: The preferred answer is (b). Discussion: This question deals with compassion and understanding. As a professional dealing with the care of patients, you are often required to help them with their emotional and psychological concerns. Responses (a), (c) and (d) dismiss the patient’s need for reassurance and lack empathy. Response (e) avoids dealing with the issue. Response (b) demonstrates caring and concern – the little extra time taken to reassure the patient can go a long way towards allaying his fears. Example: 2 Category: Empathy Scenario: You are a junior doctor who is rostered off for the afternoon. At 11.00 AM you visit an elderly patient who has been under your care for a few weeks, and is having an operation that afternoon. The old man asks you if you could please spend some time with him, as he is very anxious about his operation, and would like to ask you a few questions. You spend a while with the patient, and then decide to go home as you have an arranged commitment to attend to. The old man desperately asks if you can’t stay longer. What do you say to the patient? Choices:



a) You tell the patient that unfortunately you have a prior commitment and cannot be at the hospital that afternoon. b) You tell the old man that you have a previous commitment, which you will try to re-schedule. If this is possible, you will spend more time with him. c) You tell the old man that you have to go, however if he has any more questions you will get another doctor to answer these for him. d) You say nothing about a previous commitment, but simply agree to stay with the patient as long as possible and answer any more questions he might have. e) You say that you are feeling very ill and cannot stay long, as you have worked very long hours. Answer: The preferred answer is (d). Discussion: This situation requires you to deal with a certain degree of empathy and act in a professional manner towards one of your patients. It is obvious that this patient places a lot of trust in you, and even spending a few minutes more before attending to your other commitment may mean a lot to the patient. Thus the correct answer is (d). Example: 3 Category: Empathy Scenario: You are a nurse on a ward round with a group of doctors and medical students. The consultant doctor interrupts the ward round to go off and answer his pager. In the meantime the medical students start chatting with the junior doctors and laugh among themselves quite loudly. They are all standing near the bed of a patient who has been in severe pain all night and has just managed to fall asleep. The patient wakes up and asks you what is going on and that he cannot sleep with such a racket going on. What do you tell him? Choices: a) You tell the patient in a loud tone of voice, so that the doctors are sure to hear it, that you are sorry the racket woke him up. b) You tell the patient in a loud tone of voice that the doctors did not know that he was sleeping and had been up all night. c) You tell the patient to try to go back to sleep and tell the group to move away from the patient’s bed. d) You ask the group politely if they can move slightly away from this patient’s bed, as he has been up all night with severe pain and then tell the patient to try and sleep again. e) You tell the patient that you will complain to the consultant doctor. Answer: The preferred answer is (d) Discussion: This scenario deals with a conflict situation for you the nurse. Do you have enough empathy for the patient to tell the doctors to keep down the volume of their conversation, or do you give the patient some excuse, as reprimanding the junior doctors in front of the medical students might embarrass them. Answer (d) is the appropriate choice, as it ensures peace and quiet for the patient and avoids a direct confrontation with the doctors. 1.2 Honesty:



Honesty is an important issue in any professional healthcare setting, as honesty engenders trust, and trust is one of the most important components in any health professional-patient relationship. For Health Professionals many questions in practice will deal with the issue of honesty, often in the context of a scenario where a “little white lie” may not necessarily be cause any harm, or may help the health professional out of a sticky situation. The aim of these questions is to assess the candidate’s attitudes towards honesty and integrity in a professional setting. Example: 1 Category: Honesty Scenario: You are a nurse on a surgical ward in a public hospital. One day you accidentally forget to give a patient the anti-nausea drug that was written up with his pain relieving medication (nausea is a very common side effect of some pain medications), as you are tired, having just finished a very busy night shift. As a result of your oversight the patient becomes really nauseous. None of the doctors or nursing staff knows about your oversight (as patients can still experience nausea despite having had medication to prevent it). You decide not to fill out an incident report and not to tell anyone about your oversight. However, a couple of days later, the patient questions you about the episode of severe nausea. What do you tell him? Choices: a) You tell him that it is a common reaction to some pain relieving medications. b) You tell him that you forgot to give him an anti-nausea drug and that these mistakes sometimes happen, as the nursing staff have so many things to think of. c) You tell him that you forgot to give him an anti-nausea drug. You apologise and say that you were tired from working a night shift. d) You tell him that another nurse forgot to give him an anti-nausea drug and you apologise on the other nurse’s behalf. e) You tell him that you did give him an anti-nausea drug and that it obviously didn’t work. Answer: The preferred answer is (c). Discussion: This scenario deals with the nurse being faced with a potentially embarrassing situation, (apart from the issue of medically negligent behaviour towards the patient). The temptation is to cover up the initial mistake as in options (a), (d) and (e), but this is dishonest. In this case an apology and honest explanation might win the patient’s understanding, as in answer (b). Answer (c) is absolutely truthful. Example: 2 Category: Honesty Scenario: You are a medical student who is trying to insert a drip into a patient. The patient keeps referring to you as the “young doctor” and you are actually not sure whether the patient knows that you are only a medical student with little experience. After two unsuccessful attempts, you are hesitant to carry on, but the senior doctor has informed you that he wants you to conduct the procedure. It is obvious that the patient is getting upset at being made to suffer this discomfort. How should you proceed?



Choices: a) You apologise to the patient and tell him not to worry, as you are very good at this. b) You tell the patient that you have performed this procedure hundreds of times and are just having a bad day. c) You apologise to the patient, and tell the patient that you would rather get someone more experienced to conduct the procedure. d) You tell the patient that you are aware he is not comfortable with the situation, however it has to be done. e) You tell the patient that you are just learning and that if you fail again, the procedure will not be performed at all. Answer: The preferred answer is (c). Discussion: This situation requires you to communicate honestly with your patient. The patient’s well-being is still your prime objective, thus to get someone more experienced to conduct the procedure as in (c) might be the most appropriate course of action after all. Answers (a) and (b) show blatant dishonesty. Example: 3 Category: Honesty Scenario: You are a GP in a busy practise. A 17-year-old girl comes to see you with her mother. As part of your history taking and related to the complaint that brought the girl to you in the first place, you have to ask some intimate questions. You are concerned that the girl will not answer truthfully with her mother present. How do you handle this situation? Choices: a) You tell the mother that there is some paperwork to be filled out in the reception area and it would save time if she left the room to complete that while you have a brief word with her daughter. b) You ask the mother if she would be kind enough to do you a favour. You send her on an errand to the reception area so that you can speak to the daughter in private. c) You ask the mother if she would please leave the room while you have a chat with the daughter in private. d) You tell the mother that the daughter asked you before if she could see you alone. You hope that the daughter does not contradict your statement. e) You tell both mother and daughter that it is important you take down an accurate history and state that the girl may not feel comfortable answering all questions in front of her mother. Answer: The preferred answer is (c). Discussion: As a doctor your prime responsibility is directed towards your patient. Any interference in the way of attaining information from the patient or considering the correct course of treatment needs to be removed. Especially younger patients are often reluctant to reveal certain information in front of family members. It is important to be honest and direct in your request, which is why (c) is the preferred answer. Note that answer (e) is worded in such a way that it might offend the mother as it implies that the daughter may not trust her mother.



Section 2: COMMUNICATION SKILLS: 2.1 Conflict Resolution: Why is conflict resolution an important interaction skill? In a setting where the health of a patient is reliant not only on good communication between the patient and their health care professional, but also between health care professionals amongst themselves, anything which interferes with the communication process is potentially deleterious to the proper care of the patient. The Health Professional may be presented with scenarios describing conflict between a patient and a health professional, or conflict between patients, which needs to be mediated by another healthcare professional. These scenarios will examine the Health Professional’s attitudes and skills with regard to mediation of disagreements and efficient conflict resolution. How can conflict in a healthcare environment be resolved? At a professional level the following general pointers should be taken into account:

Focus on the Problem: It is important to focus on the relevant issues surrounding a problem in order to find a solution. Focussing on how the problem arose in the first place and how it can be solved is more important than issues such as who is to blame.

The Team Approach: United we stand – divided we fall - Usually, the first course of action in a conflict situation is to attribute blame. This does not solve the problem. It singles out one group or person, instead of uniting people as a team to solve the problem.

Compromise: Often the parties involved in a conflict situation will have to reach a compromise – each party will have to yield some ground to reach a solution that is acceptable to everyone.

The Win-Win Situation: For effective conflict resolution it is important that all parties involved feel satisfied with the solution.

The following examples illustrate some of these issues. The preferred answers emphasise:

Explaining the situation (usually to a patient) so that any misunderstanding between conflicting parties may be resolved.

Being impartial: Not taking sides is crucial in solving a conflict situation between two parties.

Suggesting solutions, which are acceptable to both parties, but may involve some compromise by each (as explained above).

Example: 1 Category: Conflict resolution Scenario: You are a nurse caring for two elderly male patients. One of the patients spends most of the day reading books. The other patient has a small portable radio, which he listens to all day. The patient reading the books is not happy about the constant noise, complaining that he cannot concentrate. He has spoken to the man with the radio, who has paid no heed to his requests for some peace and quiet. The man complains to you. What do you say? Choices: a) You ignore the situation and hope that they will resolve the problem. b) You threaten to report the complaining man to the clinical nurse consultant.



c) You explain to both patients that they have to be considerate of each other, and ask the man with the radio to turn down the volume. d) You tell the man with the radio that you have to confiscate it, if he does not turn down the volume. e) You tell the man reading the books to read out loud. Answer: The preferred answer is (c) Discussion: This is a conflict situation between two patients. As a nurse you have the choice whether to ignore the situation or to help resolve the conflict. By choosing to ignore the situation, both patients’ wellbeing and comfort are being compromised. Answer (c) is the preferred answer. It is far better to speak in a polite and friendly manner to both parties concerned and to negotiate a compromise between the patients, which will ensure a comfortable hospital environment, than to ignore the problem (a), or aggravate it (e). Threatening the man (b) will not resolve the issue in the short term and choice (d) is not appropriate either as you have no right to confiscate personal property. Example: 2 Category: Conflict resolution Scenario: You are a young nurse in the children’s ward at a public hospital. You are in charge of a ward with six boys, between the ages of eight and thirteen years. One boy’s has had his tonsils removed and is in some discomfort. His mother has informed you that her son is constantly being teased and bullied by all the other boys. How best should you handle the situation? Choices: a) You ignore the mother’s complaint, as the child might be over-reacting. b) You tell the other boys to stop bullying the child, or you will make sure that they will not get their meals that evening. c) You tell the mother that bullying does not happen in hospitals and that her child might be lying. d) You tell the mother that this problem does not fall within your job description. e) You explain to all the boys in the room that the boy being teased is not well, just like them, and has a right to be left in peace in order to fully recover. Answer: The preferred answer is (e). Discussion: In this situation your diplomatic people-skills are required. The emotional wellbeing of one of your patients is being seriously compromised. Answer (e) is the preferred answer, because you are not just reprimanding the other boys, but hopefully enlisting their cooperation and understanding. Answer (d) is incorrect because by taking no action the boys comfort and recovery are compromised. Choice (a) and (c) indicate that you do not believe the child or its mother. Without adequate grounds and investigation this is certainly inappropriate. Choice (b) constitutes entirely inappropriate behaviour. Example: 3 Category: Conflict Resolution Scenario:



You are a nurse in a maternity ward. Under your care is a young woman who has given birth to twins. Not only the adoring husband, but many relatives and friends are constantly bringing her flowers. Sharing the room with the young woman are two other ladies. One of them suffers from hayfever. As a result of the many flowers she is constantly showing signs of hayfever. She is complaining about her reaction to the many flowers. How do you handle the situation? Choices: a) You remove all the flowers from the room and inform the mother of the twins that she may not receive any more flowers. b) You tell the patient suffering from allergies, that there is actually nothing you can do, as everyone is allowed to receive flowers in hospital. c) You ignore the complaints of the patient with hayfever and hope the mother of the twins will not receive any more floral gifts. d) You offer the patient medication to alleviate the allergies. e) You discuss the situation with the patient receiving the flowers and ask if the flowers can be kept at home for her by her family. Answer: The preferred option is (e). Discussion: In this case, the wellbeing of all patients is your prime responsibility. Every patient in the hospital environment has the right to feel comfortable. Although there is no rule about receiving flowers in hospital, they are in this case however causing a great discomfort to one of your patients. Option (a) is too drastic as there is no discussion with the patient concerned. Choices (b) and (c) do nothing to help the patient with allergies, while choice (d) is only a short term measure. Option (e) is the most fair and democratic approach as it explains the situation to the mother of the twins and tries to find a solution that proves to be most beneficial for all parties concerned. 2.2 Appropriate Communication: Discussion: What does the word communication mean to you? For the next few moments I would like you to do some brainstorming by yourself. Think about: • A definition of communication • The purpose of communication • Appropriate and inappropriate communication in a professional environment Appropriate communication in a challenging situation: Health professionals may be faced with scenarios where awareness of appropriate communication skills is examined in situations where the health professional is challenged with a difficult situation or with a patient who is behaving inappropriately. The health professional may even be insulted or taunted by a patient. Responding appropriately in such a setting is extremely important. The health professional should be aware of the following issues regarding appropriate communication skills.

Respect: The patient should always be addressed in a respectful manner, even if the patient is being inappropriate.

Language: Patients are to be addressed by their title where appropriate and colloquial language and a casual or careless attitude or demeanour is inappropriate when communicating with patients.



Direct and Honest Approach: Issues or problems should be explained to patients in clear terms and the patient should never be misled or lied to. Refer to the section on Honesty.

Professional Barriers: Patients should never be discriminated against or made to feel uncomfortable, even if they are behaving inappropriately or are clearly in the wrong.

Here are some examples: Example: 1 Category: Appropriate Communication Scenario: You are a nurse working on a general ward. One of your patients, a middle-aged man in a shared room, requires regular oral administration of medication, as instructed by his doctor. You have privately been informed by one of the other patients, that as soon as you leave the room the man spits out the pills you have given him. What should you tell him? Choices: a) You inform the patient that you will tell the doctor that he spits out the tablets he should be taking. b) You confront the patient with the information you have and explain carefully to him that it is in his best interest to take the medication prescribed by his doctor. c) The next time you have given the patient his medication you unobtrusively observe his actions. If the allegations made are true you speak to him concerning the need to follow his treatment plan carefully and that it is in his best interest to follow the doctor’s orders. d) You tell the patient that you suspect that he is not taking his medication and that you shall have to report him to the doctor, as this may have very serious repercussions for his recovery. e) You explain to the patient the importance of taking the prescribed medication and then decide to stay with the patient until you have seen him swallow all the tablets prescribed and give instructions to the other nursing staff to do the same. Answer: The preferred answer is (e). Discussion: This scenario deals with appropriate communication and action in a difficult situation. As a nurse it is your duty to ensure that all instructions by the doctor are meticulously and conscientiously carried out. By implying to the patient, that you are aware of what is going on regarding his intake of medication and then explaining the importance of accepting the appropriate treatment protocol, as well as making sure that the doctors orders are properly carried out, the situation may be resolved. Thus the most accurate answer is (e). Example: 2 Category: Appropriate communication Scenario: You are a young nurse working for a pathology laboratory. It is your duty to draw blood on a regular basis from patients who are unable to get to the appropriate medical centres. Most of your patients are either bed-ridden or elderly people who have trouble getting around. Every month you have to visit an old man, who is very querulous and difficult. Whenever you attempt to get a blood sample from him, the old man jerks his arm away, inflicting injury upon himself. He then blames you for being inefficient and incompetent. Every visit is an ordeal for you. What should you do?



Choices: a) You tell the old man to keep quiet and to keep still whilst you are trying to take blood. b) You explain to the old man why you have to take blood from him, that you do not wish to hurt him and that if he holds completely still it will make your job a lot easier. c) You complain to your superior and refuse to see the old man again. d) You explain to the old man, that you are an experienced nurse and that you will make this procedure very painful if he does not keep still. e) You apologise to the old man and tell him that you are trying to do your best. Answer: The preferred answer is (b). Discussion: You may often have to deal with patients who are difficult and querulous, and who may be quite demanding or even rude to you. It is important to always communicate appropriately with these patients, explain why you are doing a procedure and how they can help you, as this will make it easier for both the carer and the patient. Choice (a) is inappropriately and rude, choice (d) is diabolical and certainly incorrect, while in choice (e) there is no further information or explanation given to the patient. Example: 3 Category: Appropriate communication Scenario: You are a young doctor working on a surgical ward. Two of your patients have undergone surgery. Both of these patients are still in recovery and need to stay there for some time. The families of both patients are anxiously waiting to speak to you when you leave the operating theatre. The first family rush towards you with questions about the well-being of their son, taking up much time with questions. The other patient’s father and wife are nervously standing by, obviously in a great hurry to speak to you, the father mumbling that he urgently needs to get back to work. What do you do? Choices: a) You briefly explain the outcome of the operation to the first family, then excuse yourself for a moment to speak to the father and wife of the other patient. You then return to the first family and answer any questions. b) You briefly explain the outcome of the operation to the first family, then excuse yourself and speak to the father and wife of the other patient for a long time before leaving the ward. c) You ask the relatives of the second patient to phone the surgeon for information later that day. d) You abruptly end your conversation with the first family and speak to the father and wife who are waiting for you. e) You call both families together and explain the results of both procedures to all of them. Answer: The preferred answer is (a). Discussion: As a health care practitioner you need to be able to communicate with patient’s families, often under distressing circumstances. It is always important to be calm and reassuring. Illness and suffering affect not only the patient, but also the families involved. The preferred choice (a) gives you time to talk to both parties and allows the father to leave after hearing the news in brief. Choices (b) and (d) imply that the needs of the second family are being put above those of the first, which is not correct.



Answer (c) ignores the immediate needs of the second patient’s family, while answer (e) violates the rights of each family to discuss this news with you in private. Section 3: PROFESSIONAL DEVELOPMENT: 3.1 Professional Conduct: What is Professional Conduct? Professional conduct is behaviour in accordance with the highest standards of character and practice, incorporating dignity, respect - for oneself, for others and for any task performed - and appropriate behaviour in accordance with the legal and ethical principles prescribed by a given profession. It is important for a health care professional to uphold these standards of conduct when dealing with patients in any given situation. Why is it important that we relate to clients or patients in a professional manner? Professional conduct is universal across different professions and essentially provides a prescribed code of interaction between the professional and the client, which allows for a very defined and (on the part of the professional) structured interpersonal communication to ensue. This allows a comfortable environment for a client to discuss or divulge information, which may be of a personal nature or which may be embarrassing or even incriminating. Professional conduct thus helps foster trust between client and professional and aids the professional in helping or serving the client effectively. The health professional should be aware of the following general guidelines of professional conduct in the medical professions:

Non-Discrimination: This includes discrimination against the client (political, religious, racial, sexist, culturalist, etc.) or discriminatory remarks about any persons in front of the client.

Confidentiality: Any dealings between client and professional are to be kept strictly confidential.

Maintenance of standards: The professional should uphold the standards of care demanded by the medical profession, even in the face of time constraints or other limited resources.

Advocacy: The professional usually represents a professional body with certain ethical, moral and legal codes of practice. Apart from adhering to these codes, criticism of colleagues, their practises or criticism of the professional body or its codes in front of a client is considered unprofessional.

Information and Consent: The professional has an obligation to keep the client informed of all proceedings and important issues concerning that client and in certain cases the client’s formal consent is required. Client information and informed consent do not fall within the scope of this lecture, however.

What is required of the Health Professional in terms of knowledge of professional conduct? ? At this level it is not important to know in detail about all the legal and ethical issues which influence the relationship between health professional and patient. It is important, however, to know that they exist. Health Professionals should be able to recognise what is blatantly inappropriate professional conduct, based on the general guidelines above and then what might be the most appropriate way of dealing with a patient. Read and discuss the following examples: Example: 1



Category: Professional Conduct Scenario: You are a nurse working on a ward. One of your new patients is a young lady who keeps demanding your attention, asking for a glass of juice, for an extra pillow, etc. You are very busy and she is taking up much of your time and not allowing you to look after your other patients. How do you handle the situation? Choices: a) You tell her loudly across the ward that you are busy. b) You gently tell her that you acknowledge that she has certain requests but that you do have to share your time between a number of patients and ask for her understanding. c) You ignore her requests and continue with your work. d) You tell her sternly that she is not the only patient on the ward and that you can’t continually come when she calls. e) You tell her that if she doesn’t stop calling you, you’ll ask for her to be moved to another part of the ward. Answer: The preferred answer is (b). Discussion: This question deals with the difficulties of maintaining professional conduct in the face of time constraints and a demanding patient. With effective communication it is usually possible to gain their understanding of your situation as in response (b). The remainder of the responses all indicate a lack of correct interpersonal communication as they are rude and impart no information to the patient. Example: 2 Category: Professional conduct Scenario: You are a nurse caring for an elderly patient in a nursing home who is gravely ill. Every time you see this patient, he tells to you that he thinks he is on the wrong medication, as he is not getting better. He has on numerous occasions made it clear to you, as well as to other staff members, that he does not believe the doctor has made the right diagnosis and that the medication is having no beneficial effect on him. He has also stated that he believes the doctor to be completely incompetent. However, when the doctor comes to see him he never discusses the matter with him. What should you do? Choices: a) You inform the doctor of the patient’s complaints. b) You inform the patient that he should discuss his concerns with his doctor at length and that you will be happy to ring the doctor to come and see the patient. c) You tell the patient that his remarks are uncalled for and that he should keep his opinions to himself. d) You agree with the patient that some doctors do not know what they are doing. e) You ignore the patient’s complaints and comments, putting it all down to the fact that he must have senile dementia. Answer: The preferred answer (b). Discussion: This scenario deals with appropriate professional conduct in a difficult setting. Often it is not possible to resolve a patient’s complaints, but effective interpersonal communication will help to resolve the situation. Choice (b) is the preferred answer because the patient’s doubts need



to be discussed with him and his fears alleviated. As his doubts are directed at the doctor and his method of treatment, it is best that the doctor be called to review the patient and discuss the matter with him. Answer (a) does nothing to immediately address the patients concerns, choice (c) is rude, choice (d) is unprofessional, while choice (e) totally ignores the patients concerns. Example: 3 Category: Professional Conduct Scenario: You are a nurse and one of your patients, an elderly man is about to be released from hospital. While he is waiting for the release forms to be processed you bring him a list of instructions written by his doctor. The list contains information regarding his medication and diet, for the next couple of days. He has a look at what his doctor has written and then tells you that he finds it impossible to decipher the doctor’s handwriting. What do you tell him? Choices: a) You tell the patient that you shall take the list back to the doctor, with the message that the patient cannot read his handwriting, but you may not be in time to see him before his release. b) You tell the patient that all doctors are hopeless and have illegible handwriting. c) You tell the patient that this is not your problem and that he should contact the doctor. d) You tell the patient that when you see the doctor you shall ask him to phone the patient at home. e) You tell the patient that you shall phone the doctor from the nurse’s station to get all the relevant instructions and ask the patient to wait until you return. Answer: The preferred answer is (e) Discussion: Before the patient has left the hospital he is still officially in your care and it is your duty to make sure, that all instructions issued by the doctor are clear to the patient, even if it means a slight delay in leaving the hospital. This is why (e) is the preferred answer, as (a), (b) and (d) are not at all helpful and (c) means you are relinquishing your professional responsibility towards the care of this patient. 3.2 Prioritising Skills: What do we mean by prioritising skills? In an ideal world, there would be unlimited resources available to the healthcare profession and everyone would have unlimited access to the best possible healthcare. Discussion: What resources can you think of in the healthcare industry? Answers might include:

Hospitals or hospital beds Medications Doctors, nurses and other health professionals The time of healthcare professionals Expensive equipment such as X-ray machines



Unfortunately, we live in a world where healthcare resources are restricted - there are many more patients than doctors, and not every hospital can have fancy, expensive equipment and hospital staff and general practitioners have time constraints in dealing with individual patients. Prioritisation is the assessment and implementation of strategies for the most effective use of limited resources. For the health professional it is important to recognise how the prioritisation of time and tasks within a hospital setting affects the interaction between patients and health professionals. The following examples all illustrate the need to balance appropriate patient care with:

The needs of each patient The needs of other patients The needs of other hospital staff Time constraints

Example: 1 Category: Prioritising skills Scenario: You are a young general practitioner working in a coastal town. Many of your patients are holiday-makers, who use your services only when on holiday. A young man who lives on the coast and has been a patient of yours for a couple of years, makes an urgent appointment to come and to see you. He has a severe stomach upset and requires medication. He brings with him to the consultation two of his friends, both holiday-makers who have the same symptoms of stomach upset. The two friends have no appointment to see you. You have a full list of patients, all of which have made appointments. What do you do? Choices: a) You consult the patient who has made the appointment and then tell his friends that you have a waiting room full of patients. The best you can do is to try and fit them in at the end of the day. b) As they have all come in to see you together, you say nothing about the other patients who are waiting to see you. You examine your regular patient first and then examine his friends briefly and give them each a prescription for their condition. c) You tell the patients friends to speak to the receptionist, who does all the bookings, to ask her to fit them in as soon as possible and tell them that they may have to wait a while. d) You tell the friends to see another doctor as you are really fully booked and cannot inconvenience your regular patients for patients who see you when they are on holiday. e) You tell your receptionist to tell the youngsters that they should seek help from another doctor as you are too busy. Answer: The preferred answer is (c). Discussion: In a medical practice, unexpected situations often arise. In this case, the two youngsters who have come along with their friend are not really critically ill, and can afford to wait until the receptionist can fit them into the doctor’s schedule, without inconveniencing too many patients. Therefore (c) is the preferred answer. Other patients may feel unfairly treated is you see all three together as in choice (b). However you do have a duty of care to these patients, and should not have to refer them to someone else or ask them to come back unless there is absolutely no other option. Thus choices (a), (d) and (e) are not the preferred answer.



Example: 2 Category: Prioritising Skills Scenario: A patient with depression comes to see you, her GP. You have diagnosed her depression some time ago and essentially she has come to get another prescription for her medication. You have a child waiting in the consulting room next door, who is in a lot of pain and who needs your attention. The lady who is with you is telling you at length about her sister who seems to be suffering from depression also. She rambles on and on and you know that you need to cut her visit short to attend to the child. What do you say to her? Choices: a) You interrupt her, excuse yourself and say that you have a very urgent case next door which requires your immediate attention. b) You interrupt her to write out her prescription, then excuse yourself and say that you have an urgent case to attend to next door. c) You interrupt her and tell her that you cannot spend more time with her as you have an urgent case to attend to. d) You listen to all her problems until she is finished and simply let the child wait. e) You ask her if she can wait for half an hour or more, as there is an urgent case you need to attend to first and that you will finish your talk with her later. Answer: The preferred answer is (b). Discussion: Prioritising skills are important when determining where to focus immediate attention, to benefit patients under your care the most. The lady in question essentially only needs a prescription renewed, so there is no point in making her wait and to continue any further irrelevant discussion with her. The patient in serious discomfort who is waiting for your care should take priority in this situation. Thus (b) would be the most appropriate choice. Example: 3 Category: Prioritising Skills Scenario: You are a doctor working in the psychiatric ward in a public hospital. The ward has an open plan and patients often just wander about in the common area. You are about to see a patient for a planned consultation before another staff meeting. You are accosted by a patient in the corridor, who proceeds to tell you at length about a last suicide attempt. You are running late and would like to complete your sceduled consultation before the staff meeting. What do you say to this patient? Choices: a) You excuse yourself, tell the patient that you have a consultation, but promise to speak to her later. b) You listen to the patient for a short time and then excuse yourself. c) You tell her that you are in a great hurry and cannot speak with her right now. d) You mention to her that she has told you all this before and that you are in a hurry. e) You tell her that you have an appointment and then a staff meeting and have no time to listen to her story again. Answer:



The preferred answer is (a). Discussion: This situation needs to be handled very delicately with appropriate communication, to ensure that the patient that approached you in the corridor does not feel rejected, even though you have little time at the moment. It would be more beneficial for you to organise an appropriate time for yourself and the patient to discuss her problems. By doing so you not only prove to her that you want to help, but also prioritise your attention regarding patients. Thus the preferred choice would be (a). END OF LEARNING MATERIAL +++++++++++++++++++++++++++++++++++++++++++++++++++++++ COMMENCEMENT OF SIX (6) TIMED TRIAL TESTS This is a strictly timed trial test. Time allowed is 45 minutes. PERSONAL DEVELOPMENT EMPATHY Question: 1 Category: Empathy Scenario: You are a resident doctor rushing to get to a ward round when a patient calls out to you and asks you to fetch him a glass of water. You are already running late. What do you do? Choices: a) Ignore him and continue on your way. You cannot afford to be late and someone else can attend to the patient. b) You tell the patient to ask the nurse, as that is his/her job. c) You fetch the glass of water despite knowing that you are already late and your senior colleagues as well as your patients will be waiting. d) You apologise and explain that unfortunately you are running late and that you will pass the request on to the patient's nurse. e) You say, "Sure, I'll get it now" and hurry off to your ward round. Question: 2 Category: Empathy Scenario: You are a nurse looking after an elderly patient who has forgotten to bring her bed slippers to hospital. She complains to you of having cold feet when she sits out of bed or goes to the bathroom. She asks you if there is anything you could do to help her. What is your response? Choices: a) You say, "No, I'm sorry. The hospital does not provide bed slippers for its patients". b) You say, "Sure I'll go and buy you some and you can consider it a present". c) You offer to phone her family and ask whether a visiting family member could pick up her pair from home and bring them in for her. d) You tell her that her cold feet are not a problem medically and she should just tolerate them. e) You advise her to discuss the issue with her family when they next visit in two days time. Question: 3



Category: Empathy Scenario: You are a nurse looking after a teenage boy who is awaiting a major operation to remove a bone tumour near his knee. He is very anxious as he has never had an operation before and is worried that he may not be able to walk normally again. As you are preparing him for his operation, he starts crying. What do you do? Choices: a) You have other patients to prepare for their operations and hurriedly rush off and get on with your duties. b) You sit down with him for as long as you can, listen to his concerns, and try to reassure him that he will most probably make a good recovery and will be able to walk again given time. c) You tell him not to be silly and that he is old enough to be brave and handle the situation. d) You sternly tell him to pull himself together and that if he does not have the operation the tumour might kill him. e) You quietly leave his room so that neither of you will be embarrassed. Question: 4 Category: Empathy Scenario: You are a nurse working in the paediatric ward of a large hospital. All your patients receive regular visits from family and friends. However, one of the boys in your care has not once had anyone visiting him and appears to be very lonely. What can you do to help? Choices: a) You ring the boy’s parents and inform them, that their son seems depressed and sad and ask if there is anything you can do to help. b) You ring the parents and ask them why they do not visit their son. c) You ignore the situation and decide to wait and see what happens. d) You tell the boy that you find this state of affairs very disappointing. e) You ask other staff to visit the boy so that he does not feel that lonely. Question: 5 Category: Empathy Scenario: You are a surgical nurse working in the operating theatre. A twelve year old girl, who has a sarcoma in her lower femur needs to have a knee replacement. Because of the seriousness of the operation the parents are allowed to accompany their daughter to just outside the operating theatre. The young girl is sedated and seems calm. Suddenly the mother starts to cry and gets more and more hysterical about the consequences of such a drastic procedure on her daughter’s future. The husband tries to calm his wife. The young girl is getting increasingly alarmed. What should you do? Choices: a) You quietly steer the mother away from the daughter’s bed-side and calmly reassure her that the best course of treatment for her daughter is being followed and that she is in good hands. Once the mother has calmed down you take her back to the daughter’ side. b) You tell the mother to pull herself together, as her crying is upsetting the young patient.



c) You tell the mother that she will have to leave immediately as the young girl is not to be upset just before the operation. d) You let the husband deal with the situation at hand. e) You quietly explain to the mother in front of the daughter that her daughter is in good hands, that the correct treatment procedure is being followed and that she needs to calm down for the sake of her daughter. Question: 6 Category: Empathy Scenario: You are a nurse working for the Blue Nursing Service. You have to pay a visit to an old man’s apartment, who is in need of nursing care. The old man lives in a block of units that mainly has elderly residents living there. Once you have treated the old man and are about to leave, you find two other elderly residents waiting outside his door. Both are complaining about various ailments and are asking for your treatment. What should you do? Choices: a) You should tell them that your time has been carefully scheduled for the day, that you will however ring up the service and ask for another nurse to be sent out to them as soon as possible. b) You ask the patients what is wrong with them and then decide on a course of action to help them. c) You tell them that you have a very busy schedule and will try to schedule them in for the following day. d) You ignore the two elderly people and continue on your way. e) You tell them that you are in a hurry and ask them to phone the Blue Nursing Service themselves to organise a visit by one of the nurses. Question: 7 Category: Empathy Scenario: You are a male nurse accompanied by an orderly, working in the orthopaedic ward. Your patient, an elderly man who has had a hip-replacement has an epidural in place to fight the intense pain. Every three hours he needs to be rolled over and have his back rubbed with ointment to prevent bed-sores. However the patient is in pain and persistently refuses to be turned. What are you to do? Choices: a) You carefully explain to the patient that even though he experiences pain, it is vital to the recovery process, that you perform the task of rubbing down his back regularly. b) You tell the patient that he should try to accept the pain and the fact that you have a duty to perform. c) You carefully explain to the patient that he is obviously going to experience some discomfort initially, but that on each occasion he will actually feel better. d) You ignore his complaints and proceed with the task at hand. e) You tell the patient that because he is experiencing pain you shall wait a day or two before rubbing down his back.



Question: 8 Category: Empathy Scenario: You are a junior doctor working in a surgical ward. Your senior doctor informs you, that the mother of a six year old patient has requested that a lump (ganglion) on her daughter’s wrist be removed at the same time as the operation on her foot is being performed. When you go to see the patient and her mother, you mention the added procedure. It becomes apparent that the young patient is frightened of the added procedure and does not want the wrist lump removed. The mother had told the senior doctor, that she did not want the added procedure to be mentioned to her daughter. Now both the mother and the young patient are upset. How should you handle this situation? Choices: a) You say that you only mentioned the added procedure, because your senior doctor asked you to. b) You explain to the patient that it is best to remove the lump at the same time as her other procedure is being performed, as it entails only one anaesthetic and will not cause her any extra discomfort. c) You tell the patient that she must have the lump removed at the same time as the other procedure as there is only one anaesthetic involved and obviously less cost involved. d) You tell the patient that it is far more convenient for the doctor to perform both procedures at once. e) You ask the mother to please speak to the child and sort this issue out with her, before any decision is made by the doctor regarding the lump in the wrist. Question: 9 Category: Empathy Scenario: You are a nurse looking after a seven year old boy, who has recently been diagnosed with a serious cancer. One afternoon he asks you if he is going to die. How do you respond? Choices: a) You tell the child truthfully: “Most probably.” b) You tell him, that he is in hospital because the constant medical care and attention will make him totally well again soon. c) You assure him that he is not going to die. d) You ignore the question and first discuss it with other staff members before dealing with the issue. e) You explain to the boy, that the constant medical care and attention from doctors and nurses in hospital affords him the best possible chance of recovery. Question: 10 Category: Empathy Scenario: You are a junior doctor who is rostered off for the afternoon. At 11.00 AM you visit an elderly patient who has been under your care for a few weeks, and is having an operation that afternoon. The old man asks you if you could please spend some time with him, as he is very anxious about his operation, and would like to ask you a few questions. You spend a while



with the patient, and then decide to go home as you have an arranged commitment to attend to. The old man desperately asks if you can’t stay longer. What do you say to the patient? Choices: a) You tell the patient that unfortunately you have a prior commitment and cannot be at the hospital that afternoon. b) You tell the old man that you have a previous commitment, which you will try to re-schedule. If this is possible, you will spend more time with him. c) You tell the old man that you have to go, however if he has any more questions you will get another doctor to answer these for him. d) You say nothing about a previous commitment, but simply agree to stay with the patient as long as possible and answer any more questions he might have. e) You say that you are feeling very ill and cannot stay long, as you have worked very long hours. Question: 11 Category: Empathy Scenario: You are a nurse caring for a child who has just undergone an operation on her spine. She is required to wear a back brace to support the spine for a few months. The little girl did not previously know that she would be required to wear a brace. She is very upset and refuses to wear it. How should you deal with this situation? Choices: a) You call her doctor, explain the situation to him and let him deal with the issue. b) You tell her that she has no choice in the matter and that she has to wear the brace. c) You tell her that you will discuss the matter with her parents and that they will force her to wear the brace. d) You carefully explain to her why it is essential she wear the brace and then coax her into putting it on. e) You tell her that she has been so brave up until now and explain to her why the brace is necessary for her full recovery. Question: 12 Category: Empathy Scenario: You are a young nurse working in an orthopaedic ward. One of your patients, a nine year old girl has just undergone a biopsy of a tumour in her lower leg, on her tibia. The girl’s parents passed away two years ago, and the only person who takes care of her is her grandmother. The little girl is very anxious about the whole procedure and is waiting for someone to reassure her about her condition. She has overheard the doctor discussing the case with her grandmother. When you come to see her next, she asks you what does it mean to: “have the limb amputated”? How do you respond? Choices: a) You explain to the young patient what amputation means, but not to worry about such things now as the doctor has not made any definite diagnosis yet. b) You tell her that amputation means that a limb is partly or totally removed. c) You brush the girl’s question aside, and tell her to not worry so much.



d) You explain to the girl that at this stage the doctors are not sure what the outcome of the biopsy may be, but that whatever the outcome, she is receiving the best possible care. e) You tell her that if the outcome is not good, the doctors are going to have to remove her lower leg, she should however not worry about the situation now. Question: 13 Category: Empathy Scenario: You are a junior doctor in a children’s ward. One of your patients is a three-month-old infant requiring an operation, which has been scheduled for the morning of the following day. It is late afternoon, when you find out that the operating-theatre has been double booked and the little girl’s operation is cancelled. You have to tell the parents who have been anxiously awaiting the procedure as their little girl is very ill. Choices: a) You tell the parents, that the operating theatre has been double-booked and that the operation has to be re-scheduled. b) You tell the parents that there has been a mix-up in the operating schedules, that these things sometimes happen and that the little girl’s operation must be re-scheduled. c) You tell the parents, that the operating theatre has been double-booked and that you shall ensure that the operation on their little girl receives top priority. d) You tell the parents that mistakes will happen and unfortunately their little girl’s operation will just have to wait. e) You explain to the parents what has taken place, reassure them that the condition of their daughter is in no way life-threatening and that you will ensure that her operation takes place at the soonest possible time. Question: 14 Category: Empathy Scenario: You are a doctor in a public hospital. You are asked to see a patient in the orthopaedic ward, who is very paranoid about his condition and the hospital environment as a whole. You know from his chart, that apart from some nasty fractures, there is nothing seriously wrong with this patient. In the middle of the consultation the patient starts becoming really aggressive. What do you say to him? Choices: a) You tell him to calm down, or you cannot examine him. b) You tell him to calm down, that there is nothing to worry about and that he will soon feel better again. c) You tell him that you will come back when he has calmed down and walk away. d) You calm him down and tell him that the discomfort and general anxiety he is feeling is quite normal and that he will soon feel better again. e) You tell him that his aggressive behaviour will not achieve anything and will only make him feel worse in the long run. Question: 15



Category: Empathy Scenario: You are a nurse looking after a patient who needs daily blood tests, to monitor for the side-effects of her medication. Because of the frequent needle pricks the patient’s arm is very discoloured, with bruising under the skin. The patient in the next bed also needs frequent blood tests, but her arm is not bruised at all. The patient with the discoloured arm feels that the nurse who collects the blood is not conducting her tests properly and refuses to let her draw any more blood. What do you say to the patient? Choices: a) You explain to the patient that you are sorry for her discomfort, but that the tests are necessary and that the bruising will eventually go away. b) You apologise to the patient for the discomfort and ask her to please be patient a while longer as the tests are necessary, while she is on the specific medication and although the nurse is doing a good job, some people bruise easier than others. c) You tell the patient that you are very sorry about her discomfort, that some people bruise easier than others and that the nurse is simply doing her job. d) You tell the patient to stop being difficult and that the tests are necessary for her general well-being. e) You tell the patient that if she refuses the blood tests, she must take full responsibility of the resulting consequences, as her medication needs monitoring. Question: 16 Category: Empathy Scenario: You are a nurse on a ward round with a group of doctors and medical students. The consultant doctor interrupts the ward round to go off and answer his pager. In the meantime the medical students start chatting with the junior doctors and laugh among themselves quite loudly. They are all standing near the bed of a patient who has been in severe pain all night and has just managed to fall asleep. The patient wakes up and asks you what is going on and that he cannot sleep with such a racket going on. What do you tell him? Choices: a) You tell the patient in a loud tone of voice, so that the doctors are sure to hear it, that you are sorry the racket woke him up. b) You tell the patient in a loud tone of voice that the doctors did not know that he was sleeping and had been up all night. c) You tell the patient to try to go back to sleep and tell the group to move away from the patient’s bed. d) You ask the group politely if they can move slightly away from this patient’s bed, as he has been up all night with severe pain and then tell the patient to try and sleep again. e) You tell the patient that you will complain to the consultant doctor. Question: 17 Category: Empathy Scenario:



You are a nurse on a medical ward. the ward is filled mainly with older patients, however there is one young girl on the ward suffering from leukemia. No one really comes to visit her. She has been quite rude to some of the nursing staff and consequently most of the staff are a little cool towards her. You know however that she is basically frustrated as she has no one to talk to. You are busy with her chart one day when one of the blood nurses is very short with the girl after she makes a fuss about having blood taken again. When the blood nurse leaves, you notice the young girl crying. What do you say to her? Choices: a) You tell her that if she started being a bit nice to people, everyone would be nice to her in return. b) You lecture her about how she should not lash out at people continually. c) You ask her if she has any family who you could phone to come and cheer her up. d) You tell her that it must be very frustrating for her to have to suffer the constant blood tests, but that she should soon get better again. e) You tell her that you can understand her frustration, that many patients get really angry about their condition, but that with care and time, things should get better again. Question: 18 Category: Empathy Scenario: You are a junior doctor on a surgical ward-round. The last patient you and the surgeon see, is scheduled for a complicated operation the next day. As you are both turning away to leave, you notice out of the corner of your eye, that this patient has burst into tears. You are due in theatre in ten minutes. What do you say to the patient? Choices: a) You pretend not to notice her tears and cheerfully wave good-bye. b) You pretend not to notice her tears and leave. c) You turn to her, tell her not to worry about anything and to get as much rest as possible before the operation. d) You ask the patient if there is anything you can do to help. You are due in theatre in ten minutes, but you can come back. Or, should you send someone else to talk to her. e) You tell the patient that you are due in theatre in ten minutes, but that you shall ask one of the nurses to come over to speak to the patient at once. Question: 19 Category: Empathy Scenario: You are a nurse looking after a patient in hospital. Visiting hours are about to start. You patient tells you that she doesn't wish to see her family today. As walk back to the nurses station, you see that patient's family, waiting to be admitted to the ward. What do you do? Choices: a) You decide that this is not an issue for you to resolve and you go off on your tea break. b) You decide that this is not an issue for you to resolve and allow the family to visit the patient. c) You tell the family to go home.



d) You approach the family and explain that them that the patient wishes not to be disturbed today, and offer to answer any queries. e) You go back to your patient and coerce her into seeing her family. Question: 20 Category: Empathy Scenario: It is lunchtime. You are a nurse looking after a male patient who is a vegetarian. He complains to you that for the third time this week he has received a non-vegetarian meal and that he is very hungry. What do you say to him? Choices: a) You tell him that you will see what you can do after you have had your own lunch. b) You apologise and say that you will contact the catering staff when you have time. c) You apologise and say that you will contact the catering staff immediately to see if they can send up the correct meal. d) You immediately phone the catering staff and tell them that they are incompetent. e) You tell him that he should take the matter up with the catering staff when they bring his next meal. Question: 21 Category: Empathy Scenario: You are a nurse looking after an Asian man. He complains to you that this "western" hospital food is bland and tasteless and asks if you can do anything about it. What do you say to him? Choices: a) You tell him that he is in a hospital and not in a hotel. b) You tell him politely that you provide nursing care only and that solving this sort of problem is not in your job description. c) You offer to go to an Asian take-away restaurant and buy him some Asian food. d) You tell him that an Asian diet will only make him ill and that he should eat what the hospital provides. e) You suggest that his family might be able to bring him some food from home (as long as this does not conflict with his medical dietary requirements). Question: 22 Category: Empathy Scenario: You are a junior doctor working on a surgical ward. One of your patients has been in the operating theatre longer than expected. You notice that his family members who are waiting in his room seem to be getting very anxious about the delay. What do you do? Choices: a) You ignore them and continue with your work. You are too busy to talk to relatives.



b) You go and tell them that you are aware of the delay but they shouldn’t worry or complain because delays occur often in large hospitals. c) You go and chat to the family casually and try to distract them from the fact that the patient is not yet back from his operation. d) You talk to the nurse looking after the patient and ask her to go and pacify the family. e) You approach them and reassure them that delays in theatre for a variety of reasons are not uncommon. You offer to contact the theatre and find out how things are progressing if the patient is delayed much longer. Question: 23 Category: Empathy Scenario: You are a junior doctor on a ward round with your senior colleagues. Together, you go to see an elderly female patient. The senior doctor examines her and then discusses her case with the other staff in attendance. It is evident to you that she has not understood any of the discussion and therefore does not clearly know what is wrong with her or what the treatment plan is. What do you do? Choices: a) You continue on the ward round – if the patient had any questions, she would have asked. b) You tell the patient’s nurse to talk to the patient if necessary. c) You return to the patient after the ward round has ended, sit down and discuss her illness and treatment in words she can understand, and then ask whether she has any questions. d) You continue with your busy schedule and do not talk to the patient – it will not make a difference whether she knows what’s going on or not. e) You pat the patient’s hand and quickly tell her not to worry about any details – you and other doctors will take care of everything. Question: 24 Category: Empathy Scenario: You are a nurse looking after a room with four male patients. At breakfast time one of the patients is usually still asleep. In the bed next to this patient is an overweight patient with a very large appetite, who is not satisfied with the amount of food provided. He regularly takes the sleeping patient’s food. The other patients in the room have complained about the food thief. Choices: a) You ignore the situation and decide since the sleeping patient does not bother to wake up for breakfast, it serves him right. b) You speak to the obese patient in front of all the other patients and tell him that he should abide by the allocated food quantity. c) You ask to speak to the obese patient privately and tell him that you will have a word with the kitchen staff, to see if they can supply him with a larger helping of food, if he agrees not to take the sleeping patient’s food. d) You announce loudly to all patients in the room that they should keep an eye out for the fat food thief. e) You tell the other patients in the room that the sleeping patient is responsible for seeing that his own meal is not stolen.



Question: 25 Category: Empathy Scenario: You are a male nurse working in the oncology (cancer) ward. You are looking after three terminally ill patients. One of the patients is mentally unstable and tends to express opinions to all in the room rather volubly. He constantly speaks about his own and everyone else’s demise and that there is no hope left. Although the other two patients realise that this man is mentally unstable, the continuous references to death are upsetting to them. You have noticed this and feel that you should do something. Choices: a) You have the patient moved to a private room, where he does not upset any other patients. b) You tell the other patients to ignore the old man. c) You tell the other patients that the old man is demented and does not know what he is talking about. d) You explain to the patient that what he is saying to the other patients is disturbing and upsetting them. e) You tell the old man to keep his opinions to himself. Question: 26 Category: Empathy Scenario: You are a physiotherapist working in a hospital caring for patients in the Orthopaedic ward. One of your patients has had a serious shoulder injury, suffering discomfort. The patient feels great pain relief when you are exercising and massaging his shoulder and he asks you to spend some extra time with him. You are already running late on your morning schedule and have several patients waiting for you to attend to them. What do you tell him? Choices: a) You tell the patient that you do not have extra time for him. b) You tell the patient that you will do your best to alleviate his discomfort until your next visit with him, but that you have other people who need your care. c) You tell the patient that he should not be so demanding and that you have other patients to attend to. d) You tell the patient that you would stay a bit longer if he gave you $50. e) You tell the nurse to massage the patient’s shoulder. Question: 27 Category: Empathy Scenario: You are a nurse in a hospital working the night-shift. A teenage boy, who has just had his tonsils removed is in your care. The youngster is sharing a ward with three other patients. Visiting hours are over, it is late and most patients are asleep. The boy’s father has arrived,



explaining that he has travelled for many hours and due to work commitments has no other opportunity to visit his son. What should you do? Choices: a) You tell the boy’s father that visiting hours are over and to return the following day. b) You tell the boy’s father, that he may wake the other patients and may not be admitted to the room. c) You tell the father that you will check to see if his son is awake and if so you are prepared to make an exception regarding visiting hours. d) You tell the father to wait, as breakfast will be served in a couple of hours. e) You offer to let the father sleep in the ward lounge until the next morning. Question: 28 Category: Empathy Scenario: You are a junior resident working in the emergency department in a public hospital. It is about 9.30 am, you have just finished the night shift after working 13 hours. It has been unusually busy in the emergency ward, as there were a couple of problem cases. You are exhausted and longing to go home to sleep. As you are about to leave, a young couple whose daughter you attended to the previous evening accost you, regarding her medical condition. They launch into a lengthy discussion, despite the fact that you explained everything to them in detail the previous evening. What should you do? Choices: a) You tell them politely that you have finished your shift and are now going home after a long night. b) You tell them that you are in a hurry to go home and that they should speak to another doctor. c) You briefly answer all their questions again and refer them to another doctor who has started on the next shift. d) You tell them that you refuse to give them any information as your shift has finished and you are too tired. e) You tell them that you have explained everything to them at length and have nothing more to say to them. Question: 29 Category: Empathy Scenario: You are a senior resident doctor working in the cancer ward. It is your lunch break and you are on the phone with your wife, who is very ill at home. One of the nurses comes rushing up to you, asking you to please come and help with a patient. He is in urgent need of more pain medication. The patient is under the care of the other resident on the ward, but the nurse has been unable to locate the other resident. What do you tell her? Choices: a) You interrupt your phone-call, tell her that this is not your patient and ask her to page the other resident doctor working on the patient’s ward. b) You tell her that you have your own troubles concerning your wife and she should stop bothering you.



c) You tell her that you are on the telephone and ask her to wait. d) You tell her that this is your private time and that the patient should wait until after your lunchbreak. e) You interrupt your phone-call, enquire about the urgency of the situation and then make your decision whether to attend to this patient immediately or not. Question: 30 Category: Empathy Scenario: You are a midwife in a labour ward. A pregnant lady complains to you that the air-conditioning is turned on too high. She cannot adequately cover herself as she is in labour. Meanwhile she is freezing, which is making her even more uncomfortable, than she already is. The air-conditioning is centrally controlled and there is nothing you can do about it. What should you say to her? Choices: a) You tell her that the air-conditioning is centrally controlled so unfortunately it cannot be turned down, but offer her additional blankets to loosely cover her. b) You tell her that there is nothing you can do about the air-conditioning and she will just have to suffer the discomfort. c) You tell her that you are really sorry about the additional discomfort, but there is nothing you can do about the air-conditioning. d) You offer to get her a blanket to cover her. e) You tell her that her labour is quite advanced and that she will soon forget about feeling cold as the pain intensifies. Answer:1 The preferred response is (d) Discussion: This question deals with the issue of empathy towards the patient. However, since you, the doctor, have certain time constraints, it is appropriate to pass on the request rather than keep your other commitments waiting. Hence answer c) is not appropriate here. Ignoring patients (answer a), or lying to them (choice e), lacks empathy and is rude. Choice b) also shows a lack of empathy towards the patient. Answer:2 The preferred response is (c) Discussion: This problem centers around empathy. Ignoring the patient’s plight (choices a and d) is not empathic. Buying gifts for patients (choice b) may be considered to be kind but is professionally inappropriate. The most empathic and appropriate course of action would be to promptly alert the patient's family and enlist their help, rather than allow the patient to remain uncomfortable for a further two days. Hence answer e) is not correct here either. Answer:3 The preferred answer is (b). Discussion: This question deals with compassion and understanding. As a professional dealing with the care of patients, you are often required to help them with their emotional and psychological



concerns. Responses (a), (c) and (d) dismiss the patient’s need for reassurance and lack empathy. Response (e) avoids dealing with the issue. Response (b) demonstrates caring and concern – the little extra time taken to reassure the patient can go a long way towards allaying his fears. Answer:4 The preferred answer is (a). Discussion: As a nurse you may often encounter situations where some conflict or difficulty exists between a patient and their family. There is not much you can do in this situation, but offer compassion and a willingness to talk about things and to help. Therefore (a) is the preferred choice, as you are not meddling in the family’s affairs, but are just pointing out the situation at hand. The courses of action proposed in (b) and (d) are professionally inappropriate, choice (c) is uncompassionate and choice (e) may not be a practical solution in a busy hospital environment. Answer:5 The preferred answer is (a). Discussion: As a health-care professional, you will often be faced with emotional outbursts from patients’ family members. A patient may be in a serious condition, which is distressing and disturbing for the family. It is likely that the patient will certainly be apprehensive and may also be frightened about the impending procedure. An empathic attitude and plenty of reassurance will often help ease this difficult situation. If you can reassure and calm the parents, they in turn can reassure the child and help normalise what is at best a harrowing experience. Therefore, choice (a) is the preferred course of action. Answer (e) may cause a further outburst in front of the patient. Choices (b) and (c) are rude and not empathetic at all. Choice (d) does not deal adequately with the situation as the husband is also anxious. Remember that both parents do not have much experience with situations such as this and you do. Answer:6 The preferred answer is (a). Discussion: This scenario requires you to deal with a situation with maturity and professionalism, taking into account your duty of care towards your other scheduled patients, as well as consideration for the feelings of those in need of your help. Option (a) covers the interests of your arranged patients for that day, and also provides the people in need of nursing care, asking you for your services, a solution to their problem. The other options do not take into account your obligation as a nurse towards your patients, and they do not provide the people in need of nursing care with aid. Answer:7 The preferred answer is (a) Discussion: This situation between patient and nurse can be resolved through empathy and appropriate communication skills. It is the nurse’s duty of care to treat the patient as best possible. By explaining carefully to the patient that although he may not be comfortable with the procedure it is necessary for a speedy recovery, will prevent further discomfort and will be beneficial, the patient’s resistance to the treatment can be broken down. Thus answer (a) is the correct choice. Answer:8



The correct answer is (d). Discussion: This scenario deals with a lack of communication skills between health care workers. It is not the senior doctors fault that he did not inform you about the added procedure, however it is also not your mistake for mentioning it to the patient. The situation can easily be resolved through effective communication with mother and patient. Answer:9 The preferred answer is (e). Discussion: This scenario deals with a high degree of empathy as well as excellent communication skills. You are not absolutely certain about the patients future prospects, but you know that a positive realistic outlook can only aid recovery. It is therefore best to assure the patient in an empathetic manner that he is being provided with the best possible chance of recovery. Thus the preferred choice is (e). Answer:10 The preferred answer is (b). Discussion: This situation requires you to deal with a certain degree of empathy and act in a professional manner towards one of your patients. It is obvious that this patient places a lot of trust in you, and even spending a few minutes more before attending to your other commitment may mean a lot to the patient. Thus the correct answer is (b). Answer:11 The preferred answer is (e). Discussion: This scenario deals with communicating effectively with the patient in order to explain a specific situation and the reason for an action. A certain degree of empathy is involved from the nurse towards the patient. Handled correctly the nurse can make the patient understand the situation and see the benefit of co-operation, which is why (e) is the preferred option. Answer:12 The preferred answer is (d). Discussion: This situation requires you to deal with a delicate situation with empathy and professionalism, as well as consideration for the feelings of the patient causing the dilemma. By reassuring the patient that she is receiving the best possible care you can alleviate her distress. Therefor (d) is the preferred answer. Answer:13 The preferred answer is (e). Discussion: Administrative mistakes may sometimes occur in the day to day running of any institution. This can sometimes prove embarrassing for hospital staff and cause distress for patients and loved ones. This scenario requires appropriate communication with the young patient’s parents. By explaining the situation to them, apologising for any inconvenience and reassuring them about their daughters condition, which is why (e) is the appropriate answer. Answer:14



The preferred answer is (d). Discussion: Patients sometimes display symptoms of stress and anxiety in a hospital environment, related to treatment procedures as well as their illness and symptoms. This situation should be handled with empathy and understanding by health care professionals at all times. This is why (d) is the preferred answer, while answers (a), (b), (c) and (e) are harsh and callous. Answer:15 The preferred answer is (b). Discussion: Often the course of treatment prescribed involves discomfort to the patient. As treatment is however unavoidable, it is important to illicit co-operation by carefully explaining the mode of treatment and by showing empathy for the resulting discomfort caused. Answer (b) is therefor the preferred answer to (a) and (c). Answers (d) and (e) are harsh and do not take the patients feelings into account. Answer:16 The preferred answer is (d) Discussion: This scenario deals with a conflict situation for you the nurse. Do you have enough empathy for the patient to tell the doctors to keep down the volume of their conversation, or do you give the patient some excuse, as reprimanding the junior doctors in front of the medical students might embarrass them. Answer (d) is the appropriate choice, as it ensures peace and quiet for the patient and avoids a direct confrontation with the doctors. Answer:17 The preferred answer is (e). Discussion: In this situation it is important to show understanding for the patients feelings and emotions. She is obviously alone and frustrated. By reaching out to her as in answer (e) she may come out of her shell and communicate her problems. Answer:18 The preferred answer is (d). Discussion: Often patients experience periods of anxiety and depression especially before an operation. It is essential to calm and reassure the patient, as a positive state of mind is important for a speedy recovery. In this case it is important the doctor shows empathy towards the patient even though he is due in theatre he offers to come back, to comfort the patient. Therefor (d) is the preferred answer. Answer:19 The preferred answer is d). Discussion: This question is about showing compassion for the patient's family while still respecting the wishes of the patient. Simply avoiding the issue demonstrates a lack of proper interpersonal communication skills and for this reason choice a) is not correct. To ignore the wishes of the patient is inappropriate, and hence answer b) is not correct either. Simply telling the patient’s family to go home without any explanation, as in answer c), is unprofessional and rude. In choice e), the wishes of the patient are not being respected, which in this case is again a demonstration of poor communication skills.



Answer:20 The preferred answer is c). Discussion: This question is about showing compassion, by not leaving the hungry patient to wait unnecessarily for a meal which he is entitled to. Answers a) and b) and e) not only show a lack of compassion for the hungry patient, but also show poor communication skills, as they lead the patient to believe that you don’t really care about his predicament. Being abusive towards the catering staff, as in choice d), again indicates a lack of appropriate communication skills as well as problem solving ability, as this course of action does nothing to solve the problem at hand. Answer:21 The most appropriate answer is e). Discussion: This question deals with respecting peoples opinions and tastes, as well communicating effectively with people, even though they may be rude or critical (in this case of western food culture). Choice a) would constitute poor communication, as you are being at best inappropriate and at worst rude. Avoiding the problem is not correct either (as in answer b). Answer c) is professionally inappropriate – avoid answers which are not appropriate or practicable in a real world situation, even though they may look like appropriate responses at first. Answer d) would constitute lying to the patient and is thus not acceptable either. Answer:22 The preferred answer is (e). Discussion: Patients are sometimes late returning from their operations for a variety of reasons ranging from the operation not starting on time, to the operation actually taking longer because there have been problems and the patient is in trouble. Waiting relatives will tend to assume the worst and will be very anxious. Response (e) is the most empathic – it communicates understanding of the family’s feelings and concerns and the desire to reassure them. Answer:23 The preferred answer is (c). Discussion: Most patients, especially in this day and age, want to be informed about their illness, the nature of the treatment, and their chances of recovery. Apart from being considerate by informing patients of the above, it is an obligation to ensure that your patient understands what is being done to her, even if this takes considerable time. Response (c) allows you to achieve this while not disrupting the ward round. Answer:24 The preferred option is (c). Discussion: You may be faced with situations where the conduct of someone else is entirely inappropriate. In these cases it is always important to maintain proper professional conduct and resolve the issue in a fair and reasonable manner. In this case the best course of action might be to reason with the patient as in choice (c). Choices (a) and (e) are not adequate solutions and choices (b) and (d) are professionally inappropriate. Answer:25



The preferred answer is (a). Discussion: This scenario needs to be dealt with in a compassionate and tactful manner. It is futile to try and discuss the situation with the mentally unstable person, or reason with him. Answers (d) and (e) are therefore not applicable. This patient cannot be made to understand that his comments are upsetting to the other patients, which is why answer (a) is the preferred choice in this particular situation. Choices (b) and (c) do not address the emotional distress that is being caused to the other two patients in the room and are thus incorrect. Answer:26 The preferred answer is (b). Discussion: This scenario deals with the difficulties of being altruistic while being restrained by other commitments. You have an equal obligation towards all patients and with effective communication it is often possible to gain the patient’s understanding of your duties. Answer (b) is an effective manner of communicating the situation to your patient without making them feel that they have received an inappropriate amount of care, which they may perceive to be the case in choices (b) and (c). Choices (d) and (e) are both professionally inappropriate. Answer:27 The preferred answer is (c). Discussion: You will often have to deal with situations which are out of the ordinary. Visiting hours are scheduled at certain hours for the benefit of patients and for the efficient running of a hospital such rules should be adhered to. In this case, considering the father’s length of travel and his predicament due to work commitments, an exception could be made, which is why (c) is the preferred choice. Answer:28 The preferred answer is (c). Discussion: Patients and family members have a right to be fully informed about their medical condition. Sometimes things need to be explained more than once in order to calm any fears or to clarify particular issues. Answer (c) is the preferred choice. In this case the young doctor is tired, but a little patient communication can still go a long way to reassure the parents of the young girl before referring them to someone who can answer their questions in more detail. Answers (a) and (b) are evasive and answers (d) and (e) are unprofessional and rude. Answer:29 The preferred answer is (e). Discussion: Ideally, the resident doctor, who’s care the patient is under, should take care of this situation, but if he cannot be located, then it is up to you to assess the situation. Locating the other resident may take a long time, while the patient is suffering. Choice (e) is preferred as the most altruistic course of action over choice (a). Choices (b), (c) and (d) show no empathy for the patient’s condition. Remember also that as a doctor, you still have a duty of care to all patients, regardless of whether they are under your direct care or not. Answer:30 The preferred answer is (a).



Discussion: This scenario involves the unfortunate discomfort of one patient, that can not be directly seen to. If you had to turn off the airconditioning then perhaps other patients who are comfortable with it on might complain. Thus you can not place other patients comfort at risk, just to please one patient. Through effective communication, she can be made to understand the situation. This is a strictly timed trial test. Time allowed is 22.5 minutes. PERSONAL DEVELOPMENT HONESTY Question: 1 Category: Honesty Scenario: You are a nurse looking after a young male patient who shares a room with five other patients. Each afternoon his girlfriend comes in to visit him and you notice that their displays of affection cause the other patients to be uncomfortable. However, you are embarrassed at approaching the young couple. What do you say to them? Choices: a) You sternly tell them to behave themselves. b) You politely explain that their actions are causing others to feel awkward and discuss alternatives such as going out for a walk during visiting hours (if medically possible). c) You laugh it off – the other patients should accept that they are in a shared room. d) You tell them loudly in front of the other patients to stop their actions. e) You wait until the patient’s parents visit and then complain to them about the situation. Question: 2 Category: Honesty Scenario: You are the senior nurse on a ward and notice that the new female doctor’s brief attire is causing discomfort and embarrassment to some of the elderly patients. One elderly lady complains to you and asks you to discreetly say something to the doctor. You are afraid that if you do there may be repercussions for all the nursing staff on that ward. What do you tell the patient? Choices: a) You tell the patient that you will confront the doctor and berate her for her inappropriate dress sense. b) You tell the patient that you cannot really tell the doctor what to wear and she should just accept the way the doctor dresses. c) You tell the old lady that times have changed and that this dress style is now fashionable. d) You tell the patient that you have received no other complaints and that she should just accept the way the doctor dresses. e) You tell the patient that you cannot really tell the doctor what to wear and that if she feels uncomfortable she should take it up with the doctor herself. Question: 3 Category: Honesty



Scenario: You are the clinical nurse consultant working in a busy hospital ward. You have noticed that one of the nurses working under you suffers from a distinctly unpleasant body odour. You know that the patients on the ward have also noticed this. One patient in particular has raised the issue with you and feels that this is a hygiene issue in a hospital environment. He has asked if you can have a quiet word to the nurse. What should tell him? Choices: a) You tell the patient you will say something to her if other patients complain as well. b) You tell the patient to discuss his concerns with the nurse herself. c) You tell the patient you will say something to her, having already decided not to say or do anything. d) You tell the patient it is not your place to discuss his concerns with the nurse and that he should lodge a complaint with the charge nurse. e) You lie to the patient and say that you have already approached the nurse in question about the problem. Question: 4 Category: Honesty Scenario: You are a nurse working in the paediatric ward in a large hospital. One of your patients is a young boy who may have meningitis. To confirm the diagnosis, a lumbar puncture has to be carried out. This procedure involves sticking a needle into the spine and can be very painful. The boy is worried about the procedure and complains that the last time he had to have an injection, the nurse assured him that it would not hurt. However, he thought the experience was terrifying and very painful. When the doctor comes into the room and prepares the syringe for the procedure, the boy sees how large the needle is and starts crying and screaming that he does not want the injection. What do you do? Choices: a) You calm the boy down and tell him that this procedure is really necessary to see what illness he has. You tell him that the doctor will be very careful and that it will soon be over. b) You tell the boy that he must calm down, or else the doctor might hurt him even more. c) You tell the boy that everyone can hear the commotion he is creating because of a needle prick and that he should be brave. d) You calm the boy and tell him that he will not feel a thing. e) You ignore the patients yelling telling him to hold still, so that the doctor can proceed. Question: 5 Category: Honesty Scenario: You are an intern on a ward round in the infective diseases ward of a large city hospital. You have just seen a patient with a highly infectious disease. You are required to wash your hands before seeing each patient, but on this occasion you forget to wash your hands before seeing the next patient. Your next patient asks you if you have washed your hands, as he is worried about contracting another infection. What do you tell him?



Choices: a) You lie and say that you have, not wanting to waste time. b) You say that you have, making a mental note not to forget again. c) You admit that you have not washed your hands and proceed with the examination. d) You admit that you have not washed your hands and go off to wash them before examining this patient. e) You make an excuse to leave the room and quickly go and wash your hands before returning. Question: 6 Category: Honesty Scenario: You are a medical student who is trying to insert a drip into a patient. The patient keeps referring to you as the “young doctor” and you are actually not sure whether the patient knows that you are only a medical student with little experience. After two unsuccessful attempts, you are hesitant to carry on, but the senior doctor has informed you that he wants you to conduct the procedure. It is obvious that the patient is getting upset at being made to suffer this discomfort. How should you proceed? Choices: a) You apologise to the patient and tell him not to worry, as you are very good at this. b) You tell the patient that you have performed this procedure hundreds of times and are just having a bad day. c) You apologise to the patient, and tell the patient that you would rather get someone more experienced to conduct the procedure. d) You tell the patient that you are aware he is not comfortable with the situation, however it has to be done. e) You tell the patient that you are just learning and that if you fail again, the procedure will not be performed at all. Question: 7 Category: Honesty Scenario: You are a young doctor inserting a catheter into an old man. You are having great difficulty with the procedure. The patient is constantly complaining to you about the painful process. You suddenly become agitated by the situation and tell the patient harshly to keep quiet. You notice that the old man is very offended by your conduct. How do you handle this situation? Choices: a) You lie to the patient and tell him you actually said something else. b) You apologise for your rudeness and hope the patient forgets about the situation. c) You wait until you have completed the procedure. Then you apologise to the patient and tell him that you are having a bad day. d) You tell the patient that you were talking to someone else and that he must be a little hard of hearing. e) You tell the old man that his constant complaining has brought on this situation. Question: 8 Category: Honesty



Scenario: You are a doctor on a hospital ward. Every medical student assigned to a doctor has a log book, in which all procedures completed by the student have to be signed for by their supervisor. One of the medical students assigned to you asks you to sign for certain procedures, which you know he has not done during the term. You agree to sign the logbook. Later one of your patients approaches you. She says she has seen the logbook while the student went back to talk to her and asks why you have signed a document stating that a student examined her when she remembers no such incident. What do you say to her? Choices: a) You tell the patient that these things are not taken seriously by anyone and that you just wanted to help the medical student. b) You tell the patient that you made a mistake and that you thought the student had examined another patient, which you signed for. c) You tell the patient that you made a mistake and that you will send the student back to examine her. d) You tell the patient that this is not your signature. e) You tell the patient that the document was confidential and that she had no right looking at it in the first place. Question: 9 Category: Honesty Scenario: You are a female junior nurse in a general ward. Whenever you do your rounds, you encounter one particular patient, an elderly male, who is always overly friendly to you and who lately has taken to hugging you and trying to kiss you. You feel increasingly uncomfortable with this. What should you tell him to stop his advances? Choices: a) You tell him in all honesty that you do not feel comfortable with his advances. b) You tell him, that you find his conduct embarrassing and to leave you alone. c) You tell him that he is embarrassing you in front of the other staff members and you would rather he keeps his distance. d) You tell him that this conduct is inappropriate for you in a work environment.You explain to him that you appreciate his friendliness, however you feel his advances are inappropriate. e) You lie and tell him that you are claustrophobic and hate being hugged by anyone. Question: 10 Category: Honesty Scenario: You are the head nurse in a cardiac ward. It has come to your attention that one of the patients regularly smokes in the ward bathroom block. Smoking anywhere in the hospital building is not allowed. You confront the patient. He says that he is just too sick to go outside, however he is unable to give up smoking. What are you to do? Choices: a) You tell him categorically that he may not smoke within the confines of the hospital building.



b) You tell him that you know it is hard not being allowed to smoke, especially if the craving is strong, but that unless he smokes outside, there is really nothing you can do about the situation. c) You tell him that there is nothing you can do about the situation, rules are rules and everyone must abide by them. d) You tell him that if it comes to your attention again that he is smoking in the bathroom you have no choice, but to call security. e) You tell him that this is a good chance for him to stop smoking, which will be better for his health in the long run anyway. Question: 11 Category: Honesty Scenario: You are a GP in a busy practice. On this particular morning the receptionist has actually double booked a number of patients as you are leaving to go on holiday the next day. A patient comes to see you. He rambles on and on about issues totally unrelated to his health and you are unable to even get a word in edgeways. What do you tell him? Choices: a) You interrupt him, tell him that your time is limited and ask him why he has come to see you. b) You interrupt him and politely tell him that you have a waiting room full of people and therefor have a limited time to spend with each patient, could he please come to the point of his visit. c) You tell him that you have a waiting room full of people and would he please come to the point or else you will never get through seeing everyone. d) You tell him you have plenty of time and listen for twenty minutes to everything he has to say, despite having other patients that are waiting. e) You tell him you have an urgent procedure in the next room and ask him to wait. You then proceed to see your other patients in the room next door. Question: 12 Category: Honesty Scenario: You are a GP in a busy practise. A 17-year-old girl comes to see you with her mother. As part of your history taking and related to the complaint that brought the girl to you in the first place, you have to ask some intimate questions. You are concerned that the girl will not answer truthfully with her mother present. How do you handle this situation? Choices: a) You tell the mother that there is some paperwork to be filled out in the reception area and it would save time if she left the room to complete that while you have a brief word with her daughter. b) You ask the mother if she would be kind enough to do you a favour. You send her on an errand to the reception area so that you can speak to the daughter in private. c) You ask the mother if she would please leave the room while you have a chat with the daughter in private. d) You tell the mother that the daughter asked you before if she could see you alone. You hope that the daughter does not contradict your statement.



e) You tell both mother and daughter that it is important you take down an accurate history and state that the girl may not feel comfortable answering all questions in front of her mother. Question: 13 Category: Honesty Scenario: You are a nurse working in the general ward. One of the nurses, whom you dislike intensely, complains that her expensive, very distinctive pen has gone missing and she thinks it was taken by a patient. You have a pretty good idea, who may have taken the pen, although you did not actually see the theft. You are alone with this particular patient one day and the drawer of the patient’s bedside table is open. You see the pen protruding from under some clothes. What do you say or do? Choices: a) Because you really dislike the nurse you decide to say nothing to the patient - let the nurse find out for herself who stole the pen. b) You decide that it is easier not to get involved at all and keep quiet about what you saw. c) You tell the patient that you saw the nurses pen in his drawer. d) You confront the patient about the very distinctive pen, which you could not help but notice in the drawer and tell the patient that you shall have to report the matter to security. e) You confront the patient about the very distinctive pen, which you could not help but notice in the drawer and ask the patient if he will speak to the nurse concerned about the matter. Question: 14 Category: Honesty Scenario: You are a nurse on a surgical ward in a public hospital. One day you accidentally forget to give a patient the anti-nausea drug that was written up with his pain relieving medication (nausea is a very common side effect of some pain medications), as you are tired, having just finished a very busy night shift. As a result of your oversight the patient becomes really nauseous. None of the doctors or nursing staff know about your oversight (as patients can still experience nausea despite having had medication to prevent it). You decide not to fill out an incident report and not to tell anyone about your oversight. However, a couple of days later, the patient questions you about the episode of severe nausea. What do you tell him? Choices: a) You tell him that it is a common reaction to some pain relieving medications. b) You tell him that you forgot to give him an anti-nausea drug and that these mistakes sometimes happen, as the nursing staff have so many things to think of. c) You tell him that you forgot to give him an anti-nausea drug. You apologise and say that you were tired from working a night shift. d) You tell him that another nurse forgot to give him an anti-nausea drug and you apologise on the other nurse’s behalf. e) You tell him that you did give him an anti-nausea drug and that it obviously didn’t work. Question: 15



Category: Honesty Scenario: You are a male nurse working in the orthopaedic ward. One of your patients is about to be discharged from hospital. His wound needs fresh dressings three times a day and you give the patient a couple of special large dressings to take home with him. He tells you that he would like a couple more and you go to fetch them. By chance you find out from two other nurses that the young man has been asking various nurses to supply him with additional dressings, ointments and bandages for days now and that by this stage he must have quite a stockpile of supplies. What do you say to the patient? Choices: a) You go back to him and tell him that there are no more of the special dressings left. b) You go back to him and tell him that there are no more of the special dressings left, but that by now he should have quite a collection as you have heard that other nurses have also supplied him with dressings. c) You get him what he wants and don’t worry about what the other nurses told you. After all, the hospital has enough supplies. d) You ask the patient if there is a reason why he needs so many dressings and bandages and relate to him what the other nurses have told you. e) You confront the patient with the fact that he has been dishonest and demand all the other supplies back from him, or you shall have to call security. Answer:1 The preferred answer is (b). Discussion: This scenario requires you to deal with an awkward situation with maturity and professionalism, as well as consideration for the feelings of the patient and his girlfriend. Response (b) attempts to gain their understanding as well as respecting their autonomy and freedom. Answer:2 The preferred answer is (e). Discussion: It is often inappropriate to criticise senior staff members, especially when it is of a personal nature. If a patient complains, one should always be honest and explain that sometimes more will be achieved if the patients deals directly with the staff member whom they have a problem with or lodge a formal complaint. Answer:3 The preferred answer is (d). Discussion: It is difficult to give constructive criticism to other staff members, especially if it concerns a personal matter. If placed in an embarrassing situation that might not be appropriate for you to deal with, it is important to be honest with the the persons involved and refer them to a person who can deal with the situation, which is why (d) is the preferred answer. Option (b) is inappropriate and option (a) does nothing to address the patients concerns. Options (c) and (e) are clearly dishonest. Answer:4 The preferred answer is (a).



Discussion: It is often necessary to perform painful medical procedures on children. Honest communication is essential to establish a sense of trust between health practitioner and young patient. In answer (a) the nurse communicates honestly with the patient and reassures the patient as much as possible, which is often all that can be done in this situation. Choice (b) is likely to ensure the patients mistrust of both you and the doctor. The remaining answers are either dishonest or avoid dealing with the patient’s distress. Answer:5 The appropriate answer is (d) Discussion: It is important to be honest in the face of making a mistake. In this case the health professional has made an honest mistake and there is the temptation to cover it up as in choices (a) and (b). This would be both medically dangerous in this case and dishonest to the patient. Choice (d) is the preferred response in this case. Answer:6 The preferred answer is (c). Discussion: This situation requires you to communicate honestly with your patient. The patient’s well-being is still your prime objective, thus to get someone more experienced to conduct the procedure as in (c) might be the most appropriate course of action after all. Answers (a) and (b) show blatant dishonesty. Answer:7 The preferred answer is (c). Discussion: This question deals not only with inflicting discomfort to the patient, but also one of impatience on the side of the doctor. An appropriate resolution of the problem at this stage requires honesty and professionalism on your behalf. By communicating with the patient and explaining the situation to him, it is likely that he will understand you. Answer:8 The preferred answer is (c). Discussion: In this situation the patient has essentially caught the doctor in the act of being dishonest. The only correct thing to do in this situation would be for the doctor to send the student back to examine the patient as in (c), thus validating the signature in the logbook. All other choices are dishonest or evasive. Answer:9 The preferred answer is (d). Discussion: This situation requires a direct and completely honest approach with the patient. The patient should be informed that you do not feel comfortable with this behaviour, thus making choice (d) the correct answer. Answer (b) may hurt the patient’s feelings, while choice (e) is blatantly dishonest. Answer:10 The preferred answer is (b). Discussion:



As a nurse you are often required to deal in a firm and friendly manner with certain situations. The patient smoking in the hospital has to be made aware of the fact that his actions are not acceptable, and that through effective communication a reasonable arrangement can be made. Answer:11 The preferred answer is (b). Discussion: Every health professional encounters patients who are overly talkative and do not realise that the health professional’s time is limited. These patients are best dealt with in a polite, but honest and direct fashion. Option (b) is a polite and honest way of interrupting the patient and proceeding with the consultation. Option (d) is dishonest to the detriment of the doctor and the patients who are waiting, whereas option (e) is dishonest and professionally entirely inappropriate. Answer:12 The preferred answer is (c). Discussion: As a doctor your prime responsibility is directed towards your patient. Any interference in the way of attaining information from the patient or considering the correct course of treatment needs to be removed. Especially younger patients are often reluctant to reveal certain information in front of family members. It is important to be honest and direct in your request, which is why (b) is the preferred answer. Note that answer (e) is worded in such a way that it might offend the mother as it implies that the daughter may not trust her mother. Answer:13 The preferred answer is (e). Discussion: Situations involving dishonesty by a patient may occasionally arise in hospitals. It is important to try and solve the issue amicably with as little commotion as possible. It is not necessary to involve the hospital security immediately, but rather to attempt to get the matter settled between the parties concerned. Therefore (e) is the preferred answer. Answer:14 The preferred answer is (c). Discussion: This scenario deals with the nurse being faced with a potentially embarrassing situation, (apart from the issue of medically negligent behaviour towards the patient). The temptation is to cover up the initial mistake as in options (a), (d) and (e), but this is dishonest. In this case an apology and honest explanation might win the patient’s understanding, as in answer (b). Answer:15 The preferred answer is (d). Discussion: This scenario deals with potential dishonesty by a patient, however there might be an innocent explanation, for example that the patient thought he might need to change dressings more often than was indicated to him. The best way to deal with this situation is with an honest and direct approach such as in choice (d). Options (a) and (b) show dishonesty on the part of the nurse. Choice (e) is extreme while option (c) avoids dealing with the problem.



This is a strictly timed trial test. Time allowed is 30 minutes. COMMUNICATION SKILLS CONFLICT RESOLUTION Question: 1 Category: Conflict Resolution Scenario: You are a nurse looking after two elderly gentlemen in a shared room. One of the men is fast asleep and is snoring loudly. Consequently the other man is unable to fall asleep and he complains to you, telling you to do something about the other man's snoring. What course of action do you take? Choices: a) You refuse to wake the snoring patient. b) You apologize sincerely, and leave to continue with other duties c) You wake the snoring patient and tell him to be quiet. d) You wake the snoring patient and kindly ask him to sleep on his side. e) You tell the first patient that it would not be appropriate to wake the other patient and rather offer the first patient some earplugs. Question: 2 Category: Conflict resolution Scenario: You are a receptionist at a doctor's surgery. It has been a very busy morning. A patient, who has been waiting for an hour, approaches you and complains that the waiting time to see the doctor is unacceptably long. What do you tell him? Choices: a) You tell him that this is not your problem - the doctor is responsible for the delays. b) You offer a sincere apology and explain that the delay has been caused by circumstances beyond your control. c) You tell him that you are not the doctor and it is not your fault. d) You lie to him and say that his name is next on the appointment list. e) You tell him not to complain, as there are people who have been waiting longer than him. Question: 3 Category: Conflict Resolution Scenario: You are a nurse looking after a room of patients in a ward, including a young man. A couple of the older patients complain that the young man often turns his television up too loud and disturbs them. They do not feel comfortable asking him to lower the volume. What do you say to them? Choices: a) You tell them that if they feel strongly, then they should confront him about the problem when it occurs.



b) You tell them that they are in a shared room and should accept that things might be a little uncomfortable. c) You tell them to complain to the nurse on duty when the volume gets too loud. d) You tell them that you will speak to the young man and point out the patients who have complained about him. e) You offer to speak to the young man, explain that the noise disturbs the other patients, and see whether you can come to some arrangement agreeable to all. Question: 4 Category: Conflict Resolution Scenario: You are a nurse working in a cancer ward. One of your patients is on a very high dose of pain medication and is suffering from hallucinations as a result. He often shouts and swears. The patient in the room next to him asks you to tell the patient to shut up. What do you tell her? Choices: a) You explain to her that the other patient’s behaviour is a result of his medication and that the best you can do is try to relocate her to another room. b) You explain to her that the other patient’s behaviour is a result of his medication and that there is nothing you can do about it. c) You complain to her that the staff has had to put up with the situation for weeks. d) You tell her to be more sympathetic towards the other patient and to be thankful that she is not also hallucinating. e) You placate her by telling her that you will see what you can do, knowing full well that you cannot do anything. Question: 5 Category: Conflict resolution Scenario: You are a nurse caring for two elderly male patients. One of the patients spends most of the day reading books. The other patient has a small portable radio, which he listens to all day. The patient reading the books is not happy about the constant noise, complaining that he cannot concentrate. He has spoken to the man with the radio, who has paid no heed to his requests for some peace and quiet. The man complains to you. What do you say? Choices: a) You ignore the situation and hope that they will resolve the problem. b) You threaten to report the complaining man to the clinical nurse consultant. c) You explain to both patients that they have to be considerate of each other, and ask the man with the radio to turn down the volume. d) You tell the man with the radio that you have to confiscate it, if he does not turn down the volume. e) You tell the man reading the books to read out loud. Question: 6 Category: Conflict resolution



Scenario: You are a nurse looking after four male patients of different ages, sharing a room and adjoining bathroom. One of the younger patients regularly leaves the bathroom in a most terrible state, with towels lying on the floor, the basin dirty and the toilet left in an unsanitary condition. After this has happened a few times, the other patients complain to you. What action do you take? Choices: a) You tell the patients to discuss the matter among themselves and to come to an agreement. b) You speak to the young man and explain to him that all patients in the room have the right to a neat, clean bathroom. He should try to leave the bathroom in the way he would wish to find it. c) You tell the young man in question not to be so dirty. d) You ignore the situation altogether, because it has nothing to do with patient-care. e) You ask the head-nurse to speak to the young man. Question: 7 Category: Conflict resolution Scenario: You are a nurse looking after a young boy who has just undergone an operation to insert a metal plate, to mend the splintered bones in his arm. Having to spend a few days in hospital, he is sharing the ward with three elderly patients, who have all undergone large procedures and are consequently in need of rest. It is the boys 10th birthday. The whole family has come to visit, to give him a small party in hospital. The elderly patients all complain to you about the commotion. Choices: a) You ask the family to leave the room and return in a day or two. b) You politely explain the situation and ask the family to be as quiet as possible, in order not to disturb the other patients. c) You tell the older patients not to be so heartless. d) You ignore the complaint and hope the noise does not carry on too long. e)You tell the older patients that they have no right to complain as the boy is entitled to have visitors. Question: 8 Category: Conflict resolution Scenario: You are a nurse caring for four middle-aged female patients, who are sharing a room and bathroom. One of the ladies, very conscious of her appearance and presentation, occupies the bathroom regularly every morning for very lengthy periods, while applying her make-up. During this time none of the other ladies in the room are able to use the bathroom and either wait, or are forced to use another bathroom in an adjoining ward. After the second morning all the ladies in the room are complaining about the situation. What do you do? Choices: a) You tell the ladies to sort the conflict out amongst themselves.



b) You wait for the bathroom to be occupied by the lady and then insistently knock on the door, telling her to hurry up and vacate the bathroom as soon as possible. c) You discuss the situation with the lady in question, explaining to her that there are three other patients, who have to use the same bathroom. You further explain that if everyone is considerate it will make things so much more pleasant for all sharing the room. d) You tell all patients in the room that they are not allowed to spend more than ten minutes in the bathroom. e) You tell the lady to let everyone else use the bathroom first. Question: 9 Category: Conflict resolution Scenario: You are a nurse looking after four patients in the orthopaedic ward. One of the patients is a young girl who had to undergo a knee operation. Another patient in the room is an old lady who has had a hip-replacement. The old lady talks, moans and screams so loudly in her sleep every night that everyone’s sleep is disturbed. The young girl in fact can’t sleep at all and is frightened. Her parents have started complaining bitterly. What do you do? Choices: a) You tell the old lady that she is being most inconsiderate and is keeping the entire ward awake. b) You discuss the situation with clinical nurse consultant and try to organise the young girl to swap beds with someone on the ward who is willing to swap. c) You ask the doctor to give the old lady more sleeping pills every night in the hope that she will sleep more deeply. d) You tell the young girl that there is nothing you can do. e) You ignore the situation in the hope that the old lady will fall into a normalised sleep-pattern. Question: 10 Category: Conflict resolution Scenario: You are a young nurse in the children’s ward at a public hospital. You are in charge of a ward with six boys, between the ages of eight and thirteen years. One boy’s has had his tonsils removed and is in some discomfort. His mother has informed you that her son is constantly being teased and bullied by all the other boys. How best should you handle the situation? Choices: a) You ignore the mother’s complaint, as the child might be over-reacting. b) You tell the other boys to stop bullying the child, or you will make sure that they will not get their meals that evening. c) You tell the mother that bullying does not happen in hospitals and that her child might be lying. d) You tell the mother that this problem does not fall within your job description. e) You explain to all the boys in the room that the boy being teased is not well, just like them, and has a right to be left in peace in order to fully recover.



Question: 11 Category: Conflict resolution Scenario: You are a nurse caring for a middle-aged female patient in an Orthopaedic ward. She is sharing a room with two elderly ladies. The middle-aged woman has varied sleep patterns, whereby she usually sleeps more during the day than at night. During her hospital stay, she likes to watch television until late at night. The two elderly ladies are complaining that they are unable to fall asleep due to the distraction of the television. What are you to do? Choices: a) You discuss the problem with the middle-aged patient and appeal to her feeling of consideration towards the other two patients in the room. b) You tell the patient causing the disturbance that she may not watch television while other patients are trying to sleep. c) You ignore the complaint and decide not to let the patient sleep during the day so that she will be worn out by nightfall. d) You offer the elderly patients sleeping tablets and eye-masks. e) You have the television disconnected by the hospitals maintenance engineer. Question: 12 Category: Conflict resolution Scenario: You are a young nurse looking after a room with eight patients in a respiratory ward, including an old man. All the other patients are either commenting or actively complaining about the elderly man’s incessant snoring at night. This either disturbs their sleep, or keeps them awake altogether. What should be done? Choices: a) You ignore the complaints. b) You inform the other patients that this is an old man and speaking to him would hurt his feelings. c) You tell the patients that they should sort the matter out amongst themselves. d) You explain the situation to the old man and offer to try and get him a private room. e) You offer to distribute ear plugs to all the patients who have complained. Question: 13 Category: Conflict Resolution Scenario: You are a nurse working for a pathology laboratory. It is your duty to visit the homes of those patients who require blood tests and are unable to get to the appropriate medical centres. One of your patients is an elderly lady, whom you visit on a weekly basis at an arranged time. Whenever you get to her house, she is either still in the bath, on the phone or otherwise occupied. You do not have the time to stand around waiting for her. What do you say to her? Choices:



a) You tell the lady that you have many other patients to visit. As she has agreed on the arranged time for you to come to see her, she should try to be ready for you, otherwise it makes you late for the rest of the day. b) You ask the lady if she wants you to come at another time. c) You tell her that you will see her at the end of day after you have attended to all other patients. d) You tell her that if she is not punctual, you cannot call any more. e) You tell her to hurry up so you can get on with your work. Question: 14 Category: Conflict Resolution Scenario: You are a nurse in a maternity ward. Under your care is a young woman who has given birth to twins. Not only the adoring husband, but many relatives and friends are constantly bringing her flowers. Sharing the room with the young woman are two other ladies. One of them suffers from hayfever. As a result of the many flowers she is constantly showing signs of hayfever. She is complaining about her reaction to the many flowers. How do you handle the situation? Choices: a) You remove all the flowers from the room and inform the mother of the twins that she may not receive any more flowers. b) You tell the patient suffering from allergies, that there is actually nothing you can do, as everyone is allowed to receive flowers in hospital. c) You ignore the complaints of the patient with hayfever and hope the mother of the twins will not receive any more floral gifts. d) You offer the patient medication to alleviate the allergies. e) You discuss the situation with the patient receiving the flowers and ask if the flowers can be kept at home for her by her family. Question: 15 Category: Conflict Resolution Scenario: You are a day-nurse working in the orthopaedic ward. One of your patients has very strong religious convictions and believes that it is his duty to preach about his beliefs to all the other patients sharing his room. They are privately complaining to you about the infringement of their privacy. What should you do? Choices: a) You tell the patient that you and everyone else respect his views, but to please keep his opinions to himself. b) You tell the patient that he should not preach to anyone and to keep his opinions to himself as others may not agree with him. c) You tell the patients who are complaining that they should sort the problem out amongst themselves. d) You tell the patient that this is a hospital ward and although everyone respects his opinions, this is not the place to try to convert anyone. e) You ignore the situation.



Question: 16 Category: Conflict Resolution Scenario: You are a physiotherapist, doing rounds in an orthopaedic ward. One of your patients is a young male football player who has had his knee reconstructed. On a daily basis his knee has to be exercised. He however consistently refuses your treatment and says that he will do the exercises himself. What are you to do? Choices: a) You tell him that he is under your care and it is your responsibility to post-operatively treat him on the instructions of his doctor. b) You tell him that to refuse treatment is his decision, but he must bear the consequences. c) You tell him that he has no choice in the matter as the treatment is compulsory and proceed to exercise his leg. d) You tell the patient that you respect his wishes and shall confer with his doctor to plan a course of action. e) You tell the patient that you have no time for difficult patients and that he will just have to go without physiotherapy. Question: 17 Category: Conflict resolution Scenario: You are a nurse working in a nursing home. You have a conflict situation between two old men who share a room. One of the men is constantly complaining to you that the other man is using his false teeth instead of his own. You have to resolve this situation, what should you do? Choices: a) You tell the man who is complaining to you that he should put his false teeth in a concealed place unknown to the other man, in order to resolve this situation. b) You tell the man who is complaining that he should resolve this issue himself. c) You speak to both men together, explain to them that this issue must be resolved and then show each one a specific place to put his false teeth so as to prevent any more mix-ups. d) You speak to both men separately and advise them to put their teeth in a specific place to resolve the situation. e) You tell the man complaining that if you have to spend time sorting out all nursing home patient’s false teeth you would never get your work done. Question: 18 Category: Conflict resolution Scenario: You are a nurse on the children’s ward. There are a few computer game consoles on trolleys which can be wheeled to the children’s beds so that they can play computer games to pass the time. Generally the children seem to share the consoles around equally, or the mums make sure, that all kids get a go. One of the boys however tearfully complains to you that he never seems to get a go on the consoles. What do you tell him?



Choices: a) You tell him that you will speak to the other kids to let him have a turn. b) You tell him that you will tell the other kids not to leave him out. c) You speak to all the children together to say that everyone should have an equal turn on the consoles and that they should not leave anyone out. d) You tell him to ask his mother to sort out the problem. e) You tell him that you shall speak to each child individually to say that everyone should have an equal turn on the consoles and that they should not leave anyone out. Question: 19 Category: Conflict Resolution Scenario: You are a junior resident doctor working in a public hospital. One of your patients, admitted to your ward with a serious fracture, really dislikes the senior doctor you are working for. Apparently she has had a bad experience of some sort with him in the past. When she realises that the senior doctor she dislikes will be attending to her, she sends for you and insists that she be transferred immediately to another hospital. As she is a public patient she cannot be given another bed and cannot be transferred. What do you say to her? Choices: a) You explain to her that she cannot be transferred as she is a public patient and that she must just tolerate the senior doctor. b) You explain to her that she will have to deal with her dislike of the doctor. c) You tell her that she cannot be moved at all and that she shall have to deal with her dislike of the doctor. d) You explain to her that she cannot be transferred as she is a public patient. e) You tell her that she should speak to the senior doctor about the matter. Question: 20 Category: Conflict Resolution Scenario: You are a nurse in a children’s ward. It has just been discovered that one of your young patients has head lice and requires treatment for it. The mother of the child in the next bed wants her child moved. The hospital is full and all beds are occupied. What do you say to the mother? Choices: a) You explain to her, that unfortunately there are no other beds available and the child cannot be moved. b) You explain to her that there are no other beds available for the child to be moved, but every effort will be made to protect her child from contracting the head lice. c) You tell her that every effort will be made to contain the head lice. d) You tell her that the parents of the other children in the ward are also concerned, there are however no additional beds available, but every effort will be made to contain the head lice. e) You tell her that the other parents are also worried, but that there is actually no cause for concern.



Answer:1 The preferred answer is (e). Discussion: In this case, waking the sleeping patient to appease the other patient is not appropriate, and it is best to communicate this to the patient in a direct and honest fashion. In this case it would be more appropriate to help the patient who is still awake. Thus answers c) and d) are not the best answers in this case. However, to simply refuse to wake the sleeping patient without explanation (choice a), indicates poor communication skills. Likewise, simply apologizing without attempting to help the patient (answer b), does not constitute effective communication and achieves nothing. Answer:2 The preferred answer is ( b). Discussion: Effectively communicating with people when circumstances are out of your control can be difficult. In this situation the most effective and appropriate approach is honesty and empathy for the frustrated patient. Shifting the blame (choices a) and c), constitutes poor communication. Lying to the patient is inappropriate (answer d), and being confrontational with a frustrated patient (e) also shows poor interpersonal skills. Answer3: The preferred answer is (e). Discussion: As a nurse, you sometimes have to deal with conflicts that arise between your patients. Most patients will respond positively if you politely explain the situation to them and attempt to negotiate an arrangement that will keep everyone happy, as in response (e). Answer:4 The preferred answer is (a). Discussion: This question deals with interpersonal communication in a difficult setting. Often it is not possible to resolve a patient’s complaint, but effective communication will help them to understand and therefore accept the situation. Therefore choice (a) is a better answer than choice (b). Answer (d) is inappropriate and rude, whereas choice (e) would constitute lying to the patient. Answer:5 The preferred answer is (c) Discussion: This is a conflict situation between two patients. As a nurse you have the choice whether to ignore the situation or to help resolve the conflict. By choosing to ignore the situation, both patients’ wellbeing and comfort are being compromised. Answer (c) is the preferred answer. It is far better to speak in a polite and friendly manner to both parties concerned and to negotiate a compromise between the patients, which will ensure a comfortable hospital environment, than to ignore the problem (a), or aggravate it (e). Threatening the man (b) will not resolve the issue in the short term and choice (d) is not appropriate either as you have no right to confiscate personal property. Answer:6 The preferred answer is (b).



Discussion: This scenario requires you to deal with an awkward situation with maturity and professionalism, as well as consideration for the feelings of the patient causing the dilemma. Response (b) attempts to gain the young man’s understanding, as well as respecting his own freedom. The response merely points out to the patient the importance and need for consideration to the other patients in the room, thus making everyone happy. Answers (a),(c),(d) and (e), may present a temporary solution, do however not address the issue at root cause. Answer:7 The preferred answer is (b). Discussion: In dealing with conflicts between patients it is important to try to resolve the conflict with compromise, while also being aware of the rights of each party. The older patients are entitled to a quiet ward environment as much as the young patient is entitled to have visitors. Thus choices (c) and (e) are not correct. Patients tend to respond positively if you politely explain the situation to them and attempt to negotiate an arrangement to suit all parties involved. Option (b) takes into account the interests of all concerned, without favouring any party. Answer:8 The preferred answer is (c). Discussion: This is a situation where you have to step in and resolve a conflict situation. Most patients tend to respond positively, if the matter is discussed with them and an arrangement is negotiated that will keep everyone happy. By pointing out politely how a lack of consideration is affecting the other patients, the lady’s cooperation is sure to be enlisted. Answers (a) will bring about further conflict amongst the patients, whereas answers (b) and (e) will cause acute embarrassment to the lady in question. Answer (d) is unrealistic and not workable. Answer:9 The preferred answer is (b). Discussion: This question deals with conflict resolution and compassion. The older patient is, without intention on her part, disturbing the other patients’ sleep and it would be cruel to berate her regarding her nocturnal vocalisations (a). Option (c) is not appropriate as this is not a clinical problem and the doctor may disagree, whereas choices (d) and (e) do not address the conflict situation at all. Answer:10 The preferred answer is (e). Discussion: In this situation your diplomatic people-skills are required. The emotional wellbeing of one of your patients is being seriously compromised. Answer (e) is the preferred answer, because you are not just reprimanding the other boys, but hopefully enlisting their cooperation and understanding. Answer (d) is incorrect because by taking no action the boys comfort and recovery are compromised. Choice (a) and (c) indicate that you do not believe the child or its mother. Without adequate grounds and investigation this is certainly inappropriate. Choice (b) constitutes entirely inappropriate behaviour. Answer:11 The preferred answer is (a).



Discussion: As a nurse caring for patients you have to be capable of handling complaints to the satisfaction of all parties concerned. Answer (a) is the most appropriate way of solving this problem in order come to an agreement. Answers (b), (d), and (e) are all inappropriate as they unfairly deal with the issue from only one party’s point of view. Choice (c) is inhumane. Answer:12 The preferred answer is (d). Discussion: The question deals with a conflict situation where one individual is singled out by a group. By communicating with this patient and explaining the situation to him, it is likely that he might understand the impact of his snoring on everyone else in the room, and will not be offended if moved to a another part of the ward, or a private room, if one is available. Ignoring the issue, as in choices (c) and (e), is not correct, and offering to give everyone else in the ward ear plugs (e) is not a practical solution either. Answer:13 The preferred answer is (a). Discussion: As a nurse you are sometimes required to deal in a firm and friendly manner with certain situations. The service you provide is a community service, which involves the cooperation of all concerned. In this case the lady has agreed for you to see her at a regular pre-arranged time. If she is then unavailable, it is your duty to tell her that you have an equal obligation to all patients and have an allocated amount of calls per day to make. You can only spend a minimum amount of time with each patient. Answer:14 The preferred option is (e). Discussion: In this case, the wellbeing of all patients is your prime responsibility. Every patient in the hospital environment has the right to feel comfortable. Although there is no rule about receiving flowers in hospital, they are in this case however causing a great discomfort to one of your patients. Option (a) is too drastic as there is no discussion with the patient concerned. Choices (b) and (c) do nothing to help the patient with allergies, while choice (d) is only a short term measure. Option (e) is the most fair and democratic approach as it explains the situation to the mother of the twins and tries to find a solution that proves to be most beneficial for all parties concerned. Answer:15 The preferred answer is (d). Discussion: This is a conflict situation between patients. As a nurse you have the choice of becoming involved or ignoring the situation at hand. By choosing to ignore what is happening, the comfort of your patients is being compromised. The preferred answer is therefore (d), while (c) and (e) do not address the complaint. Answers (a) and (b) are too direct and harsh. Answer:16 The preferred answer is (a) Discussion: As a health care professional, it is your obligation and responsibility to attend to the needs of all patients who fall under your duty of care. This however can often be made very difficult if the patient does not want to accept your care. This situation can only be resolved through



appropriate communication, explaining to the patient the importance of your treatment with respect to speed and quality of recovery. Thus the correct answer is (a). Answer:17 The preferred answer is (c). Discussion: This conflict between the two patients can be resolved, through effective communication, and professionalism on your behalf. To avoid a re-occurrence of the problem the best solution is to allocate a specific place for each patient to put his belongings. Answer:18 The preferred answer is (c). Discussion: As a health care worker it is your duty to see that everyone under your care is comfortable and content. In the children’s ward games are often shared around to occupy the youngsters and it is important to ensure that no patient is left out. To speak to all the children together ensures their combined co-operation. Therefor (c) is the preferred answer. Answer:19 The preferred answer is (d). Discussion: This situation requires professionalism and integrity from you the nurse. The patient’s private problems with the senior doctor have nothing to do with you. It is simply your duty to make the patient aware of the regulations concerning patient transfers. Answer (d) is therefor the preferred answer. Answer:20 The preferred answer is (d). Discussion: In this situation it is important to keep the prime objective of nursing-care in mind. You are occasionally required to deal with patients who unwillingly are presenting problems for other patients. By explaining to the mother that you are doing your best to contain the lice and to make sure that the other patients will not be infected, is the obvious response you can give to her. This is a strictly timed trial test. Time allowed is 30 minutes. COMMUNICATION SKILLS APPROPRIATE COMMUNICATION Question: 1 Category: Appropriate Communication Scenario: You are a nurse working on a general ward. One of your patients, a middle-aged man in a shared room, requires regular oral administration of medication, as instructed by his doctor. You have privately been informed by one of the other patients, that as soon as you leave the room the man spits out the pills you have given him. What should you tell him? Choices: a) You inform the patient that you will tell the doctor that he spits out the tablets he should be taking.



b) You confront the patient with the information you have and explain carefully to him that it is in his best interest to take the medication prescribed by his doctor. c) The next time you have given the patient his medication you unobtrusively observe his actions. If the allegations made are true you speak to him concerning the need to follow his treatment plan carefully and that it is in his best interest to follow the doctor’s orders. d) You tell the patient that you suspect that he is not taking his medication and that you shall have to report him to the doctor, as this may have very serious repercussions for his recovery. e) You explain to the patient the importance of taking the prescribed medication and then decide to stay with the patient until you have seen him swallow all the tablets prescribed and give instructions to the other nursing staff to do the same. Question: 2 Category: Appropriate Communication Scenario: You are the nurse looking after a patient in the emergency department. He is yet to be seen by a doctor. He tells you that he has to go outside for a cigarette. You understand his impatience but the doctor may well come to see him while he is outside. What do you tell him? Choices: a) You tell him that he is not allowed to go for a cigarette while at the hospital, and that he will simple have to wait or leave. b) You tell him that smoking is bad for his health and prohibit him from going outside. c) You explain to him that while he has been waiting for a while, a doctor may well come along to see him any moment and it would be unfortunate if he were not present at the time. d) You tell him that the doctor will be in to see in five minutes, knowing full well that the wait may be longer. e) You sternly tell him to exercise some control and discipline. Question: 3 Category: Appropriate communication Scenario: You are a male nurse in an orthopaedic ward. You have a young man in your care who has undergone an operation to remove a bone cancer from his right hip, and has had extensive reconstructive surgery. The patient’s catheter has recently been removed, but he is still to be confined to his bed in order to rest his hip. He refuses to use the bed pan, however, and insists on walking to the bathroom. The patient tells you he has to go to the toilet now and tries to get out of bed. What do you tell him? Choices: a) You firmly tell the patient that he may not get up and that he has to use the bedpan. b) You arrange for an orderly to help aid the young man to the bathroom and to stay there with him. c) You tell the patient that you need the doctor’s consent on the issue and will speak to him in the morning, when he does his rounds. d) You tell the young man not to be difficult and to stay in bed, or else you will break his good leg.



e) You tell the patient that he may use the bathroom, but that he may get dizzy and nauseous when getting up, and that he may severely injure his operated hip if he has a fall. Question: 4 Category: Appropriate communication Scenario: You are a young nurse working for a pathology laboratory. It is your duty to draw blood on a regular basis from patients who are unable to get to the appropriate medical centres. Most of your patients are either bed-ridden or elderly people who have trouble getting around. Every month you have to visit an old man, who is very querulous and difficult. Whenever you attempt to get a blood sample from him, the old man jerks his arm away, inflicting injury upon himself. He then blames you for being inefficient and incompetent. Every visit is an ordeal for you. What should you do? Choices: a) You tell the old man to keep quiet and to keep still whilst you are trying to take blood. b) You explain to the old man why you have to take blood from him, that you do not wish to hurt him and that if he holds completely still it will make your job a lot easier. c) You complain to your superior and refuse to see the old man again. d) You explain to the old man, that you are an experienced nurse and that you will make this procedure very painful if he does not keep still. e) You apologise to the old man and tell him that you are trying to do your best. Question: 5 Category: Appropriate communication Scenario: You are a home-care nurse, working for the Blue Nursing Service, a non-profit, Christian-based organisation offering its services to the community. One of your elderly patients who needs regular care lives alone and is very lonely. It is obvious that she looks forward to your visits tremendously and tries to draw them out under any pretext. While you do not mind spending some extra time with this lady, she does however make you regularly late for other home-care visits. What should you do? Choices: a) You tell the lady that you are in a hurry and have to go. b) You stay with the lady for a while and explain to her that you enjoy seeing her, but that you have a very busy schedule and have many other patients to attend to and thus cannot be with her for too long. c) You stay with this lady and make yourself late for other appointments. d) You tell the lady that you might have some more time on your next visit. e) You arrange for another nurse to care for the old lady. Question: 6 Category: Appropriate communication



Scenario: You are a receptionist working at a Medical Centre. It is late afternoon and past closing time. You have been run off your feet all day and are very tired. The doctor still has two patients waiting to see him. He is at the moment consulting with a young female patient. She has taken up a lot of his time already and the other two patients are becoming very impatient. What should you do? Choices: a) You buzz the doctor and tell him that he is running very late. b) You apologise to the patients and tell them that the doctor has been fully booked all day, with several emergencies cropping up in between, but should not be much longer. c) You tell the two remaining patients that it may be best for them to come back another time. d) You ignore the two waiting patients and hope that they will not complain to you. e) You remark to the two remaining patients, that you would also like to go home and that this particular doctor is usually running late. Question: 7 Category: Appropriate communication Scenario: You are a male nurse looking after four patients in an orthopaedic ward. One of your patients, a middle-aged man, is constantly pressing his call button for extra attention. He has had a small procedure done on his foot, and should not be in too much discomfort. He does however constantly seek extra attention and pampering from all nursing staff, complaining about everything, from the pillows in his bed, the air-conditioning, the food, the other patients in the room etc. What do you say to this patient? Choices: a) You tell him to stop bothering you and that you will attend to him later on. b) You perform all his requests and hope that he stops harassing you. c) You explain to the patient that his wellbeing and comfort are your prime concern. However, you feel that he is not in any discomfort and is taking up time that you should be spending with other patients. d) You explain to the patient that his wellbeing and comfort are your prime concern. However, you have many duties to perform and he should try to be reasonable when pressing the call-button. e) You have a maintenance engineer disconnect his call button. Question: 8 Category: Appropriate communication Scenario: You are a young doctor working on a surgical ward. Two of your patients have undergone surgery. Both of these patients are still in recovery and need to stay there for some time. The families of both patients are anxiously waiting to speak to you when you leave the operating theatre. The first family rush towards you with questions about the well-being of their son, taking up much time with questions. The other patient’s father and wife are nervously standing by, obviously in a great hurry to speak to you, the father mumbling that he urgently needs to get back to work. What do you do?



Choices: a) You briefly explain the outcome of the operation to the first family, then excuse yourself for a moment to speak to the father and wife of the other patient. You then return to the first family and answer any questions. b) You briefly explain the outcome of the operation to the first family, then excuse yourself and speak to the father and wife of the other patient for a long time before leaving the ward. c) You ask the relatives of the second patient to phone the surgeon for information later that day. d) You abruptly end your conversation with the first family and speak to the father and wife who are waiting for you. e) You call both families together and explain the results of both procedures to all of them. Question: 9 Category: Appropriate communication Scenario: You are a surgical resident in a large hospital. You have nearly completed your rounds in the ward, with only one more patient to see. This patient is about to undergo major surgery the next day, to remove a large cancer from his colon. He is very concerned about the operation. Although everything about his condition, the operation and post-operative care has already been explained to him at length previously, he again has many of the same questions to ask you. You are scheduled for an important meeting and are already running very late. What do you tell your patient? Choices: a) You tell the patient that you are in a hurry and have no time right now. b) You tell the patient that you have already explained everything to him and that you have other matters to attend to. c) You tell the patient that you will answer his questions again before he undergoes the operation and arrange a time to see him after the meeting. d) You tell the patient that he shall have to come to terms with his condition and that there are many people suffering from the same cancer. e) You answer his questions again at length and miss your meeting. When questioned about your conduct, you tell your superiors that your patient takes precedence over any meeting, no matter how important. Question: 10 Category: Appropriate communication Scenario: You are a young, busy, unmarried general practitioner. You have finished all your consultations at the surgery for the day, but you still have three home visits to attend to. Your first port of call is an elderly lady, who has severe arthritis. She has been your patient for a number of years. Once you have examined the old lady and have given her a prescription, she shows you to the kitchen and says that she has cooked you dinner, because, she says, you have no one to look after you. You are very embarrassed, as you still have two other house calls to make. However, you do not want to upset this lovely old lady. What should you tell her? Choices:



a) You decline her offer, apologise and say that you have other patients to see. b) You thank the lady and ask her to put the food in a container, so that you can take it with you and eat it later. c) You thank the lady for the unexpected gesture, then kindly explain to her that you appreciate her thoughtfulness. However you are not allowed to take food from her and besides, you usually manage quite well on your own. d) You accept the offer, hurriedly eat the dinner and let the other patients wait. e) You explain to the lady that this situation puts you in a professional and personal dilemma and it would be best if she didn’t cook you dinner again. Question: 11 Category: Appropriate communication Scenario: You are a paediatric nurse caring for a little girl who is gravely ill. She needs around-the-clock attention and various different medications to be administered. You have heard the parents mention to the doctor that they are very much against all medicines and try to approach all health problems through alternative methods. The parents do, however, reluctantly concede that in this case their little girl needs conventional treatment for her condition. Every time you give the prescribed medications to their daughter, however, the parents complain and ask many questions about whether the medication is really necessary and what the harmful side-effects are. It is obvious to you that the little girl is greatly distressed by the constant arguing. What are you to do? Choices: a) You tell the parents that the medication and medical treatment their daughter is receiving has been prescribed by her doctor and that they should speak to him. b) You ignore them and continue to give the girl the various medications. c) You tell the parents that you only give the patient their prescribed medication. It is not your position to give them any information at all. d) You tell the parents that alternative therapies are nonsense and that they should be grateful for the treatment that their daughter is getting. e) You tell them at length what is being given to their daughter, even though you are not sure about all the facts pertaining to her management. Question: 12 Category: Appropriate communication Scenario: You are a nurse working in the paediatric ward of a large hospital. One of your patients, a ten-year old little girl, has had a biopsy on a bone tumour in the lower right femur. The biopsy report indicates that the tumour is malignant. When you come to her bedside the next day, she asks you what the word “malignant” means. She overheard a conversation between visitors, who thought she was asleep and were discussing her case. Although she was unsure of the meaning of the word, she found the content of the conversation distressing. What should you say to her? Choices: a) You tell her that she does not have anything to worry about and that you are doing your best to make her better. b) You tell her that the visitors she overheard must have been discussing someone else. c) You explain to the little girl what the word “malignant” means. However, this does not mean that if someone has a malignant tumour they will not get better and fully recover.



d) You tell her that malignant cancer is cancer that spreads through the body and destroys various body organs, and that people with it usually die early. e) You tell her that the best person to explain it to her would be her doctor and that she should ask him on the ward round tomorrow. Question: 13 Category: Appropriate communication Scenario: You are a young doctor assessing a patient’s chest and breathing. While you are trying to listen to the chest with your stethoscope, the nurse continues to ask the patient several questions. When the patient is speaking you cannot listen to his breathing as you only hear his voice drowning out everything else. What do you say or do? Choices: a) You ask the nurse to leave you both alone, so that you can get on with your assessment. b) You tell the nurse to be quiet. c) You tell the patient to be quiet. d) You explain to both of them, that it is much easier to listen to the chest, if the patient is not speaking and ask if they would please oblige. e) You tell them, that you will come back when they have finished their conversation. Question: 14 Category: Appropriate communication Scenario: You are a young, happily married doctor, working in a medical centre. One of your patients is a very attractive young woman in her late twenties. You have noticed over the last couple of weeks that her visits to you, all concerning very minor ailments, have increased in frequency. You are in fact slowly gaining the impression that she has amorous intentions towards you. There is nothing medically wrong with her and she seems to try and spend as much time as possible in consultation with you, where she tries to draw you into conversations about non-medical topics and is very flirtatious. What do you say to her? Choices: a) When she comes for a consultation again, you examine her thoroughly and tell her that you cannot find anything wrong with her. You try to find out if there is another underlying reason for her visits, which you may have missed, such as depression or abuse. b) You tell her that it would be best to get a second opinion and refer her to another doctor. c) You tell her that she is wasting your time, as she is perfectly healthy. d) You tell your receptionist to let the young lady know that you are too busy to see her. e) You confront the young lady and ask her if she is sexually interested in you. Question: 15 Category: Appropriate communication Scenario:



You are a junior doctor at the end of an overnight shift. You are in the middle of dealing with a patient who is recovering well, but has been very irritable lately, when your pager beeps. You tell the patient that you have to answer this call and if it is urgent you may have to come back and see him later. The patient becomes very irate and starts verbally abusing you, telling you that you have not finished with him yet and that he obviously isn’t important enough for you to have the courtesy to finish dealing with him. What do you say to him? Choices: a) You tell the patient that although his care is important to you, there are other patients that also require your care and that you will be back to see him as soon as you can. b) You tell the patient that although his care is important to you, this call may be of a more urgent nature than his problems are right now. c) You tell the patient that you must answer this page and that you will certainly be back to see him soon. d) You tell the patient that you must answer this page and that he is not exactly the sickest person in hospital at the moment. e) You say that you will come back and see him as soon as possible, just to appease him, knowing full well that you can leave him to be taken care of by the regular day staff in the morning. Question: 16 Category: Appropriate Communication Scenario: You are a nurse doing your rounds with a surgeon. You notice that he takes very little time to answer properly any questions his patients put to him. His manner is short and brusque. This rushed approach clearly disturbs some of the patients and they complain to you about it. What are you to do about this situation? Choices: a) You tell the patients, that there is not much you can do about the situation and keep your opinions about the doctor’s manner to yourself. b) You explain to the patients that the doctor seems brusque because he has a very full schedule, but that he is actually a very good doctor and well respected. c) You go back to the patients who seemed to have questions and if possible, try to answer their queries. d) You tell the patients that you shall ask the doctor if he could perhaps spend more time with them, as it is obvious that some of them wish to discuss their health concerns with him. e) You tell the patients that if they have questions they should insist on an answer from the doctor, as he is a very good doctor who only seems brusque because he has a full schedule. Question: 17 Category: Appropriate communication Scenario: You are a junior doctor working in a children’s ward and are called to speak to the father of a patient. The father wants to take the child home, because he feels that he can look after the child equally well at home. Although the child is only on oral medication, it would however be better to observe him for another twenty-four hours. What do you say to the father? Choices:



a) You bluntly tell the father that he can take the child home if he wishes, but that it is against medical advice and he will have to take full responsibility, should any consequences arise. b) You accuse the father of behaving in a negligent, uncaring manner towards his son. c) You explain to him that he obviously has his son’s best interests at heart and that he will therefore understand that it would be best to keep the child in hospital for a while longer for observation. d) You call security and have the father removed from the hospital as he is causing trouble. e) You carefully explain to the father that although he wishes to take his son home, he really has no choice in the matter as he needs to abide by the doctors’ decision to keep the young patient for observation. Question: 18 Category: Appropriate communication Scenario: You are a nurse working on a general ward. One of your patients, an old man of seventy-six, has emphysema. He is constantly spitting out phlegm. The old man does not spit the phlegm into the container provided however, but on the floor. You have pointed out the container provided to expectorate into on various previous occasions but your patient ignores your request. How should approach the situation? Choices: a) You tell your patient that he better start spitting into the provided container, or else you will have to inform the doctor about his bad behaviour. b) You carefully explain to the patient that his conduct is not appropriate. c) You wait until the end of the day, then give the patient a cloth and a bucket and tell him to clean up his mess. d) You carefully explain to the patient that his conduct is not appropriate and ask if there is any particular reason why he keeps spitting on the floor and not in the container provided. e) You tell the man that if he does not stop making a mess next to his bed, you are going to inform his family about his bad behaviour and get them to reprimand him. Question: 19 Category: Appropriate communication Scenario: You are a doctor working in an antenatal clinic, where pregnant ladies come for medical check-ups. An appropriate physical examination is a routine part of each consultation. During one consultation, a patient, who does not speak English very well, agrees to the physical examination, but when you start examining her abdomen, she suddenly slaps you. What do you say to her? Choices: a) You tell her that to examine her abdomen, to determine the position of the baby, is part of the examination, which she agreed to in the first place. b) You tell her that her behaviour is inappropriate and childish. c) You ask her why she slapped you. d) You immediately apologise and ask if she understood what you meant when you first asked if you could examine her. e) You immediately apologise but remind her that she did agree to be examined by you.



Question: 20 Category: Appropriate Communication Scenario: You are a nurse working on a general ward. One of your patients, who has been hospitalised for some time is moved to another ward, which is old and quite decrepit. The hospital is filled to capacity and another patient is moved to your patients room, as the bed is needed. Your patient is very unhappy about this situation and complains bitterly to you. What do you tell her? Choices: a) You tell her that you fully understand how she must be feeling, but that this situation is totally out of your hands, as you are not in charge of the process of allocating beds. b) You tell her that you fully understand how she must be feeling, but that this situation is totally out of your hands, as you are not in charge of the process of allocating beds, you will however find out who could be contacted to do something about the situation. c) You tell her that the bed is needed by someone in a far worse state of health and that she should be glad that she is feeling better. d) You tell her not to worry about anything, as she will leave the hospital soon anyway. e) You tell her that this situation is out of your hands and that she should speak to someone in the hospital administration. Answer:1 The preferred answer is (e). Discussion: This scenario deals with appropriate communication and action in a difficult situation. As a nurse it is your duty to ensure that all instructions by the doctor are meticulously and conscientiously carried out. By implying to the patient, that you are aware of what is going on regarding his intake of medication and then explaining the importance of accepting the appropriate treatment protocol, as well as making sure that the doctors orders are properly carried out, the situation may be resolved. Thus the most accurate answer is (e). Answer:2 The preferred answer is (c). Discussion: This question deals with communicating with the patient in order to explain a situation or a reason for directing their action. Smoking is bad for one’s health (b) and not smoking does require some control (e), but these are not the main reasons for stopping the patient in this instance. Responses (a) and (d) are inaccurate. Response (c) explains the situation and is likely to gain his understanding. Answer:3 The preferred answer is (e). Discussion: You may sometimes have to deal with patients who wish to take matters into their own hands, unaware of the possibly harmful consequences. It is up to you to explain to the patient why their behaviour might cause them harm, as reasoning with them will certainly give a better result than simply giving them orders (a) or being inappropriate (d). Choice (b) may still not be the safest option and choice (c) avoids dealing with the issue at hand. Answer:4



The preferred answer is (b). Discussion: You may often have to deal with patients who are difficult and querulous, and who may be quite demanding or even rude to you. It is important to always communicate appropriately with these patients, explain why you are doing a procedure and how they can help you, as this will make it easier for both the carer and the patient. Choice (a) is inappropriately and rude, choice (d) is diabolical and certainly incorrect, while in choice (e) there is no further information or explanation given to the patient. Answer:5 The preferred answer is (b). Discussion: This situation requires compassion and empathy from you. Answer (b) is the correct answer because it addresses the problem in a polite and friendly manner, explaining that you have many other patients, who also look forward to your visits and who need care and attention. Certain situations have to be dealt with in a manner as not to compromise the patient’s emotional well-being. Choices (a), (c), (d) and (e) do not deal with the needs of all patients under your care. Answer:6 The preferred answer is (b). Discussion: This situation requires good communication and some reassurance. It is your duty not to discredit the doctor in any way. By explaining the situation to the two waiting patients, as in choice (b), you are communicating effectively and avoiding an embarrassing confrontation. Responses (a), (c) and (e) are may be viewed as being unprofessional, while (d) does not deal with the issue at all. Answer:7 The preferred answer is (d) Discussion: This scenario deals with the issue of communicating appropriately and effectively with a patient who is unreasonably demanding. By telling the patient that you have his wellbeing at heart, but that there are others requiring your serious attention, you may gain his understanding and cooperation regarding your position. Choice (d) is therefore the preferred answer. Choices (a) and (e) are professionally inappropriate, while choice (b) does not resolve the issue at hand. Choice (c) is incorrect, as making an unfounded judgement about the patient’s wellbeing is not appropriate. Answer:8 The preferred answer is (a). Discussion: As a health care practitioner you need to be able to communicate with patient’s families, often under distressing circumstances. It is always important to be calm and reassuring. Illness and suffering affect not only the patient, but also the families involved. The preferred choice (a) gives you time to talk to both parties and allows the father to leave after hearing the news in brief. Choices (b) and (d) imply that the needs of the second family are being put above those of the first, which is not correct. Answer (c) ignores the immediate needs of the second patient’s family, while answer (e) violates the rights of each family to discuss this news with you in private. Answer:9 The preferred answer is (c).



Discussion: Every patient has the right to fully understand his or her medical condition and any procedures that are about to be undertaken. It is essential that the patient is content and feels satisfied about his or her depth of understanding, regarding any operative procedures. It is the duty of every health care professional to ensure this, even if it means explaining things to the patient several times. Every medical practitioner also has a responsibility to their colleagues and other patients, however. If it is possible to see the patient at a more appropriate time and not miss other commitments, then this is the obvious course of action. Thus choice (c) is the preferred answer over choice (e). Choices (a), (b) and (d) do not deal with the patient’s queries and constitute unprofessional conduct. Answer:10 The preferred answer is (b). Discussion: As a doctor, effective communication with patients is essential, especially when delicate situations arise. In this particular case, the doctor does not wish to upset the old lady or hurt her feelings. On the other hand, the old lady’s gesture, although kind, is rather presumptuous. The young doctor has to explain to her that he has a duty of care towards his other patients and may not be neglectful of them. Answer:11 The preferred answer is (a) Discussion: As a health-care practitioner you often have to deal with difficult patients as well as difficult family members. However, patients and family members have the right to be informed about treatment and medication received in hospital. It is natural for the parents in this scenario to be concerned about the wellbeing of their daughter. They are in favour of alternative treatments, and they are entitled to this opinion. It is inappropriate for you to criticise this opinion, hence choice (d) is incorrect. Choices (b) and (c) constitute inappropriate communication, as to give some information or reassurance before referring them to the doctor would be helpful and comforting. Choice (e) is certainly inappropriate as you do not know all the facts and are not qualified to give expert medical advice. Answer:12 The preferred answer is (c). Discussion: It is your duty to be open and honest with your patients and to address patient’s questions regarding their health status to the best of your ability. Although the situation may be very difficult, due to the seriousness of the patient’s condition, it is however possible to give an honest answer without upsetting the patient as in (c). Answers (a) and (b) are not truthful. Answer (d) is far too harsh and shocking to the patient, whereas choice (e) is evading the issue. Answer:13 The preferred answer is (d). Discussion: Sometimes people can unintentionally irritate you and it is then tempting to be curt and rude. It is far easier for others to comply with your wishes if they understand your reasons. Therefore a quick explanation can go a long way as in (d). The other responses may be interpreted as being rude. Answer:14



The preferred answer is (a). Discussion: You may be confronted with situations where the patient’s behaviour is suspect but not inappropriate. In this scenario the doctor suspects the patient has amorous intentions, because she keeps coming to see him, although there is obviously nothing wrong with her. She has however not displayed any overtly inappropriate behaviour and to confront the patient with the issue may result in embarrassment for the doctor, the patient, or both (hence option (e) is incorrect). Answers (b) and (d) are attempts to evade the issue and the doctor might miss an important psychosocial issue that the patient has not been able to communicate directly. Choice (c) is dismissive and rude. In choice (a) the doctor acts professionally by ruling out other potential problems rather than jumping to conclusions. Answer:15 The preferred answer is (a). Discussion: As a junior doctor, many demands may be made on your time, especially when you are working on the wards after hours. Patients may not always understand that you may be called away at any time to attend to a more urgent case and may even take it as a personal affront if it does happen. The best strategy is to explain the situation to the patient as politely as possible and arrange to come back if you are indeed called away, as in choice (a). Choice (d) is impolite and answer (e) is dishonest. Answer:16 The preferred answer is (c). Discussion: This situation is a typical communication problem between patient and health care worker. The method of communication the doctor chooses with his patients is not your concern as you are the nurse. It is unprofessional for you to speak behind the doctors back to patients, however if the patients feel inadequately informed, it is within your duty of care to answer any of their queries. Therefore (c) is the preferred answer. Answer:17 The preferred answer is (c). Discussion: This situation deals with appropriate communication with the patient’s guardian. It is your duty of care towards the patient to inform the guardian of the consequences of his intended actions. Thus the preferred answer is (c), as you explain carefully to the boy’s father that his son has a more effective and complete chance of recovery by staying in the hospital. Answer:18 The preferred answer is (d). Discussion: The situation requires you to deal with the patient in a firm professional manner but also with compassion. For the nurse there are issues of hygiene as well as hospital standards to consider, but also that the patient may not have understood your request. Through effective communication the nurse may sort out the problem. Thus the answer is (d). The other choices do not adequately address the problem at hand. Answer:19 The preferred choice is (d).



Discussion: In this scenario, the doctor correctly asked for permission to do the examination, but it is possible that the lady, whose English was not very good, did not fully understand what the doctor meant. In this case it is best for the health professional to apologise for any discomfort and ask if the patient did not understand what was asked as in (d) and then make sure that adequate explanation is given. The other choices do not address the situation adequately. Note also that if a patient agrees to something she doesn’t understand, then this is not a proper (informed) consent. Answer:20 The preferred answer is (b). Discussion: As a health care professional it is your duty to see to the well-being of all patients under your care. Any upheaval and additional worry may have a negative effect on a patients health. Situations where patients have to be moved because the beds are needed are not uncommon in public hospitals, but can be dealt with in a fashion which is not too disruptive for the patients concerned. This is why (b) is the preferred answer. This is a strictly timed trial test. Time allowed is 30 minutes. PROFESSIONAL DEVELOPMENT PROFESSIONAL CONDUCT Question: 1 Category: Professional Conduct Scenario: You are a female nurse looking after a middle-aged man on the orthopaedics ward. One day he seems frustrated and suddenly tells you that he thinks you are ugly and that he hates it here. What is your response? Choices: a) You burst into tears and verbally abuse the patient. b) You tell him that you may be ugly but at least you are not crippled. c) You ignore the patient's outburst and try to find out what is frustrating him. d) You ignore the patients outburst but refuse to anything for him for the rest of your shift. e) You tell the patient to keep his opinions to himself. Question: 2 Category: Professional Conduct Scenario: You are a male resident doctor in a labour (obstetrics) ward of a hospital. A Muslim lady arrives at the hospital in labour. She refuses to be examined by a male doctor because of her cultural background. However, you are medically required to examine her. What do you do? Choices: a) You ask the patient if she would agree to be examined by a female doctor instead, and try to find a female doctor on duty to perform the examination. b) You tell the patient you will refuse to admit her to hospital if she does not submit to the examination.



c) You order her to submit to an examination. d) You tell her that in Australia she should be willing to adapt her cultural practices. e) You feel sorry for her and admit her to hospital without an examination. Question: 3 Category: Professional Conduct Scenario: You are a doctor in a busy general practice surgery. You see a male patient, but speaking to him is made very difficult by the presence of his two children, who are being loud and rowdy. Their mother is present as well, and cannot seem to control them. You are slowly losing patience. What do you say to the family? Choices: a) You ask the family to come back tomorrow if the children are well behaved. b) You tell the children to shut up or else you will be forced to smack them. c) You tell the patient and his wife that if they cannot control their children, they should not bring them to the surgery. d) You suggest that the mother might like to take the children outside for a moment while you have a few minutes alone with the patient. e) You tell the patient that you cannot see him today and ask him to come back alone some other time. Question: 4 Category: Professional Conduct Scenario: You are a doctor on a ward and are sitting at the nurse’s station busily writing in your patients’ charts. The phone rings and you answer it. It is the daughter of one of the patients, phoning to see how his is. You aren’t actually looking after the patient so you do not know. What do you say to the relative? Choices: a) You tell them that you are not looking after the patient and that you are too busy to find out how the patient is. b) You explain that you are not the patient’s doctor but will try to find the doctor or nurse looking after the patient so that they can talk to her. c) You tell her that she has phoned the wrong ward, planning not to answer the phone when she calls again. d) You tell her that she has phoned at a busy and inconvenient time and ask her to phone later. e) You do not know the patient but he is most likely well so you go ahead and tell his daughter that he is fine. Question: 5



Category: Professional Conduct Scenario: You are a doctor working in the emergency department and you are inserting a drip into a patient. You are having difficulty when a senior nurse comes along and tells you in front of the patient that your technique is all wrong. The patient tells you that he thought all along that you were doing something wrong, because the procedure was very painful. What do you say to the patient? Choices: a) You tell the patient that you know what you are doing and that the nurse’s comments were really inappropriate, especially in the patient’s presence. b) You tell the patient that you are the doctor, you know what you are doing and will not accept criticism from a nurse. c) You tell the patient to wait, while you talk to the nurse in private, then drop what you’re doing and ask the nurse to step outside with you. d) You assure the patient that you have done this many times, and although you are being careful, this procedure is often painful. e) You tell the patient that this is an incompetent nurse and to ignore her. Question: 6 Category: Professional Conduct Scenario: You are a nurse working on a ward. One of your new patients is a young lady who keeps demanding your attention, asking for a glass of juice, for an extra pillow, etc. You are very busy and she is taking up much of your time and not allowing you to look after your other patients. How do you handle the situation? Choices: a) You tell her loudly across the ward that you are busy. b) You gently tell her that you acknowledge that she has certain requests but that you do have to share your time between a number of patients and ask for her understanding. c) You ignore her requests and continue with your work. d) You tell her sternly that she is not the only patient on the ward and that you can’t continually come when she calls. e) You tell her that if she doesn’t stop calling you, you’ll ask for her to be moved to another part of the ward. Question: 7 Category: Professional conduct Scenario: You are a nurse looking after a young patient on the children’s ward. The patient’s parents come to visit at 5 pm and ask if they can speak to the doctor. The doctor is not on the ward at present. What do you tell them? Choices: a) You tell them that the doctor is not around and ask them to try again tomorrow. b) You tell them that the doctor usually only comes to see the patient during ward rounds and that they should make a concerted effort to be present at those times. c) You tell them to try and phone the doctor from home over the next few days.



d) You tell them that you will go and look for him, and then avoid dealing with them for the remainder of your shift. e) You offer to try to contact the doctor now, and if unsuccessful, arrange a meeting time for the following day. Question: 8 Category: Professional conduct Scenario: You are a nurse doing rounds with a young intern. An elderly lady needs a drip inserted. The intern, keen for the experience, undertakes the task. You are observing the procedure. It is difficult for the young man to find a suitable vein. After several unsuccessful attempts it is quite obvious that he is finding the task very difficult. The patient is becoming more and more distressed. What do you tell her? Choices: a) You tell the lady that you will try to find a more senior doctor, then push the young intern aside and tell him that he is not carrying the procedure out properly. b) You tell the patient not to worry and then ask the young doctor to stop hurting the old lady. c) You keep quiet and hope that the young doctor will eventually find a vein. d) You tell the patient that the intern is not very capable and offer to call the IV service to insert the drip for her. e) You tell the patient that this can be a complicated procedure but that she is in good hands. Question: 9 Category: Professional conduct Scenario: You are a nurse caring for an elderly patient in a nursing home who is gravely ill. Every time you see this patient, he tells to you that he thinks he is on the wrong medication, as he is not getting better. He has on numerous occasions made it clear to you, as well as to other staff members, that he does not believe the doctor has made the right diagnosis and that the medication is having no beneficial effect on him. He has also stated that he believes the doctor to be completely incompetent. However, when the doctor comes to see him he never discusses the matter with him. What should you do? Choices: a) You inform the doctor of the patient’s complaints. b) You inform the patient that he should discuss his concerns with his doctor at length and that you will be happy to ring the doctor to come and see the patient. c) You tell the patient that his remarks are uncalled for and that he should keep his opinions to himself. d) You agree with the patient that some doctors do not know what they are doing. e) You ignore the patient’s complaints and comments, putting it all down to the fact that he must have senile dementia. Question: 10



Category: Professional conduct Scenario: You are a twenty-five year old female doctor working in a large public hospital. Not only are you very attractive, but you also look much younger than your actual age. It happens to you frequently that patients either question your ability and competence, or simply assume that you are too young to be a doctor. One of your patients, an elderly man, questions everything you say in front of the nurses and then tells them later that he does not believe what you are saying to be correct, as you cannot possibly have enough experience. How should you react? Choices: a) You ignore him all together. b) You explain to him in a friendly manner that you are a qualified doctor, that you have studied the required curriculum and that he need not question your decisions. c) You ask the nurse to speak to him. d) You tell him that your qualifications are adequate enough to handle his particular case. e) You tell him that he has the right to a second opinion and that you will ask another doctor to see him. Question: 11 Category: Professional conduct Scenario: You are a junior doctor working on an orthopaedic ward and one of your patients has just had a major back operation. He needs an X-ray to assess his progress. You fill out the correct form and hand it to the receptionist to organise the X-ray. The following day when you see the patient, you ask the nurse to see the X-ray. She takes you aside and tells you that the clinical nurse consultant first wanted to discuss the need for further X-rays with the senior doctor on the ward. The patient has realised that there seems to be a problem concerning his X-rays and wants to know what is going on. What do you say? Choices: a) You tell the patient that sometimes nurses wrongly take it upon themselves to override doctor’s orders. b) You tell the patient that this is a small misunderstanding and not to worry about it, the X-rays will be done as you ordered. c) You tell the patient, that you shall seek out the nurse concerned and ask that in the future she check with you directly if she has a query regarding any tests. d) You tell the patient that the X-rays are not urgent at all and shall be done in due course. e) You say nothing and take the patient to the X-ray department yourself. Question: 12 Category: Professional Conduct Scenario: You are a young intern in a public hospital. It is Christmas and you have been rostered to work over the Christmas days in order to have New Year’s Eve and New Year’s Day off from work. You feel a bout of the flu coming on already on Christmas Eve, but decide that you must go to work, in spite of your condition. On Christmas Day you are running a temperature and feeling terribly ill, coughing severely. You know that to call on one of your colleagues at this time of the year would ruin their Christmas, so you go to work after all. Several patient



comment that you are not well and one patient asks you whether you would not infect everyone around you. What do you say to her? Choices: a) You tell her that you have no choice in the matter and that someone has to look after the patients. b) You tell her that you are taking some strong medication for your condition and you should be better in a couple of hours. c) You tell her that you have no choice in the matter, but that the risk of infecting the other patients is very low. d) You tell the patient that you cannot inconvenience any of your other colleagues at this time, so you have no choice but to work, but that the risk of infection is very low. e) You tell her that you are not really ill at all and that you look and sound worse than you are. Question: 13 Category: Professional Conduct Scenario: You are a senior nurse working in a private hospital. A patient complains to you that one of the nurses working on your ward pays no attention to her appearance and often comes to work looking really untidy and unkempt, portraying an unprofessional image. One or two other patients have also remarked on this. How should you handle this situation? Choices: a) You tell the patient that this nurse obviously does not care about the hospital’s professional conduct, but that you shall speak to her about paying more attention to her appearance. b) You tell the patient that the hospital has certain standards to uphold and you shall make suggestions to the nurse about neatening her appearance. c) You tell the patient that you have told this nurse several times already to tidy up her act. d) You tell the patient that she needs to make a formal complaint to the hospital administration about the nurse. e) You tell the patient that you shall speak to the nurse concerned. Question: 14 Category: Professional Conduct Scenario: You are a nurse and one of your patients, an elderly man is about to be released from hospital. While he is waiting for the release forms to be processed you bring him a list of instructions written by his doctor. The list contains information regarding his medication and diet, for the next couple of days. He has a look at what his doctor has written and then tells you that he finds it impossible to decipher the doctor’s handwriting. What do you tell him? Choices: a) You tell the patient that you shall take the list back to the doctor, with the message that the patient cannot read his handwriting, but you may not be in time to see him before his release. b) You tell the patient that all doctors are hopeless and have illegible handwriting. c) You tell the patient that this is not your problem and that he should contact the doctor.



d) You tell the patient that when you see the doctor you shall ask him to phone the patient at home. e) You tell the patient that you shall phone the doctor from the nurse’s station to get all the relevant instructions and ask the patient to wait until you return. Question: 15 Category: Professional Conduct Scenario: You are a doctor working in the emergency section of a large hospital. You are very busy one night with all the staff worked off their feet. While you are doing an assessment on a patient another staff member rudely questions your judgement in front of the patient. You immediately notice, that the patient seems to be quite astounded by the derogatory remark directed at yourself. How should you handle this situation? Choices: a) You ignore the comment, continue with your work and later privately tell the patient that this particular doctor has a very bad bed-side manner. b) You tell the patient that you do not agree with the doctors comments. c) You tell the patient that the other doctor is out of line and you will have a word with him later. d) You ask the patient why he is alarmed and tell him that this happens sometimes when all staff members are stressed. e) You talk to the patient privately and tell the patient that everyone has had a really busy night and apologise. Question: 16 Category: Professional Conduct Scenario: You are a senior nurse attending to a female patient in the company of two young interns. A very attractive young nurse who works on your ward walks by.The two young doctors make loud comments about the nurse’s good looks in front of you and the patient. The patient a middle-aged lady is obviously embarrassed by the comments and tells you that she finds such behaviour out of place. How should you react? Choices: a) You tell her to ignore their comments. b) You explain to the patient in front of the young doctors, that their remarks were uncalled for. c) You later privately tell the patient that you have decided to inform the resident doctor about their inappropriate behaviour. d) You tell her that you shall speak to the two young doctors in private about their behaviour. e) You apologise to the patient in front of the two doctors subtly embarrassing them. Question: 17 Category: Professional conduct



Scenario: You are a nurse in the cancer ward of a public hospital.Your elderly mother is a patient in the ward and is under your care. Because you are her daughter, she constantly calls for you and wants extra attention, requiring you to spend more time with her than with any of the other patients under your care. Other staff members and patients have noticed this and you feel that you must speak to your mother about the issue. What do you say to her? Choices: a) You carefully explain to the patient, your mother, that you need to give equal attention to all patients under your care and cannot be seen to favour a family member in any way. b) You carefully explain that you do not have extra time to spend with her, as you have other patients under your care as well. c) You carefully explain that you need to give equal attention to all patients under your care and cannot be seen to favour a family member in any way, but that you can spend extra time with her when you are off duty. d) You reprimand the patient, your mother, and tell her that you do not wish to get into trouble with the ward sister over this issue. e) You tell her that you are not allowed to spend any extra time with her. Question: 18 Category: Professional Conduct Scenario: You are a junior doctor admitting a patient for day-surgery. The patient complains to you at length how, when she saw the specialist surgeon who was to operate on her that day, he was really rude and very brusque with her. She asks you what you think of this particular doctor. How should you answer her? Choices: a) You tell her that this doctor comes across to patients as being brusque, but that he is a very good doctor and that she could not be in better hands. b) You tell her that sometimes doctors come across as being brusque or rude, because they have a lot on their minds. c) You tell her that you are sure that the doctor did not mean to be rude and that she must be imagining it. d) You tell her that this particular doctor is sometimes rude to patients, but that he is actually a very good doctor and that she could not be in better hands. e) You tell her that you totally agree with her. Question: 19 Category: Professional Conduct Scenario: You are a GP in practise with five other doctors. Some patients see whoever is available when they come in. One patient tells you that he saw one of your colleagues, who happens to be a friend of yours, the previous day and then proceeds to tell you at length, what a complete idiot he thinks your colleague is. What do you tell him? Choices: a) You tell him that you do not wish to discuss your colleagues. b) You tell him that it is unprofessional conduct, for you to discuss a colleague with him.



c) You tell him that this colleague is actually a dear friend of yours and that you don’t think him an idiot at all. d) You tell him that your colleague is known to be a very thorough doctor, who is very popular with all the other patients. e) You tell the patient that if he thinks this particular doctor to be an idiot, to rather always see one of the other doctors instead. Question: 20 Category: Professional Conduct Scenario: You are a nurse looking after a patient who has just returned from an operation. He complains that he is very itchy (a common side effect of the pain killers used during and after an operation) and is becoming distressed by it. He asks if there is any medication that you can give him to relieve the itch. What do you say to him? Choices: a) You apologise and tell him that you are unable to give him the medication without a doctor’s order. b) You reassure him that the itch is a common side effect and that it will wear off eventually. c) You suggest that he try to distract himself from the itch and take his mind off it. d) You tell him that there are medications to relieve the itch but that they must be prescribed by the doctor before you can administer them. You offer to contact the doctor as soon as you can. e) You tell him that the itch is a common side effect of the pain killer and that if he wants adequate pain relief he should be willing to accept the itch. Answer:1 The preferred answer is c). Discussion: The patient is frustrated and is letting his frustration out on the people around him. As a professional caretaker it is important not to take such outbursts seriously, but rather to try to ascertain what the root cause might be. Neglecting or refusing to care for a patient in any way is professionally negligent, thus answer d) and e) are incorrect. Being verbally abusive or derogatory towards a patient is unprofessional and uncaring. For this reason answer a) and b) are unacceptable responses. Answer:2 The preferred answer is (a). Discussion: This question is about balancing respect for other people's culture and modesty with professional responsibility. A female doctor could perform an examination and presumably this would be more acceptable to the patient. This would fulfil the medical requirement, as well as not impinge on the patient’s modesty. Refusing to admit the patient, as in choice b), if she refuses to be examined, is threatening to the patient, apart from being ethically inexcusable. Ordering the patient to perform some action is completely unprofessional and demonstrates very poor interpersonal communication skills. Answer d) shows a failing to respect the patient’s culture, which is inappropriate, whereas admitting the patient without an examination (choice e), is professionally inappropriate.



Answer:3 The preferred answer is (d) Discussion: Being rude to the family, directly or in an applied manner, is inappropriate and certainly demonstrates a lack of proper interpersonal communication skills, and threatening violence to the children is totally unacceptable. Hence choices a), b) and c) are incorrect. Answer (e) is not truthful and is also professionally inappropriate. Asking the children and the mother to wait outside for a short while is an acceptable alternative. Answer:4 The preferred answer is (b). Discussion: This questions deals with understanding the concerns of patients’ relatives for their well-being. Response (b) demonstrates an effort to help the relative. Response (a) and (d) dismiss the validity of her concern while (c) and (e) are blatant lies. Answer:5 The preferred answer is (d). Discussion: This question deals with the difficult situation when conflict arises between staff members. It is important to handle the situation with professionalism, while still providing care for the patient. Response (d) reassures the patient, while dealing with the situation professionally. Although the nurse behaved in a most unprofessional manner, the doctor should deal with her behaviour privately, as the well-being of the patient is a priority. Answers (a), (b), (c) and (e) display unprofessional behaviour from the doctor. Answer:6 The preferred answer is (b). Discussion: This question deals with the difficulties of maintaining professional conduct in the face of time constraints and a demanding patient. With effective communication it is usually possible to gain their understanding of your situation as in response (b). The remainder of the responses all indicate a lack of correct interpersonal communication as they are rude and impart no information to the patient. Answer:7 The preferred answer is (e). Discussion: It is natural for parents to be concerned about their child’s progress in hospital and to want to be updated on events as soon as possible. It is unreasonable to make them wait for the doctor indefinitely as in responses (a), (b) and (c). Response (d) is unkind. Response (e) communicates caring, compassion, and the willingness on your part to help the parents. Answer:8 The correct answer is (e). Discussion: This scenario deals with the difficult situation where conflict may arise between staff members in front of a patient. It is important to handle any such situation with professionalism and diplomacy, whilst still providing the highest level of care for the patient. It is never appropriate to embarrass a team member or colleague in front of a client or patient. In this case, criticising the intern will simply make the patient more distressed and the intern more nervous. Reassuring the patient as in choice (e), will calm the patient down and thus make the intern’s task easier.



Answer:9 The preferred answer (b). Discussion: This scenario deals with appropriate professional conduct in a difficult setting. Often it is not possible to resolve a patient’s complaints, but effective interpersonal communication will help to resolve the situation. Choice (b) is the preferred answer because the patient’s doubts need to be discussed with him and his fears alleviated. As his doubts are directed at the doctor and his method of treatment, it is best that the doctor be called to review the patient and discuss the matter with him. Answer (a) does nothing to immediately address the patients concerns, choice (c) is rude, choice (d) is unprofessional, while choice (e) totally ignores the patients concerns. Answer:10 The preferred answer is (e). Discussion: As a doctor your professional ability may sometimes be doubted by patients. In that case it is necessary to reassure the patient of your position and responsibility as a doctor. However, the patient may have a genuine concern and certainly has the right to a second opinion. Confirmation of what you have already told him by a more senior doctor may also result in the patient having more trust in your ability. This is why option (e) is the preferred answer over options (b) and (d). Choices (a) and (c) avoid dealing with the situation. Answer:11 The preferred answer is (b). Discussion: There are times when nursing staff will have concerns, often valid, about medical plans for a patient. There may even be times when the correct protocol for querying a procedure may be disregarded by a staff member. The clinical nurse consultant in this scenario was arguably wrong in going over your head to query the patient’s management plan. However, the breach in protocol should still be dealt with professionally and appropriately, as in answer (b) as the patient need not know the full extent of what has taken place. Answer:12 The preferred answer is (d) Discussion: When working in the medical profession, many unexpected situations may arise. It may happen that health care professionals become ill and in spite of this have to do their duty in hospital especially during the Festive Season and public holidays. It is up to the health care professional to determine whether he is able to carry out his duties concerning patients as it is often very difficult to find a replacement doctor. At the same time no harm may come to the patients coming into contact with the doctor. The preferred answer is (d) because it reassures the patient, while explaining the situation to her at the same time. Answer:13 The preferred answer is (e). Discussion: What this situation constitutes is a clear lack of professional conduct by a nurse looking unkempt and slovenly. Patients have a right to complain about anything which meets with their disapproval. Through appropriate communication skills, the nurse can be made to understand the importance of her appearance in a professional environment such as a



hospital. Thus (e) is the preferred answer. Answers (d) and (a) are too harsh and would probably create conflict between the two nurses, whereas (b) and (c) do not resolve the situation through effective communication. Answer:14 The preferred answer is (e) Discussion: Before the patient has left the hospital he is still officially in your care and it is your duty to make sure, that all instructions issued by the doctor are clear to the patient, even if it means a slight delay in leaving the hospital. This is why (e) is the preferred answer, as (a), (b) and (d) are not at all helpful and (c) means you are relinquishing your professional responsibility towards the care of this patient. Answer:15 The preferred answer is (e) Discussion: This situation deals with professional conduct. Conflicting opinions between health professionals should never be voiced in front of patients, as this is unsettling and confusing. The preferred answer is therefor (e) as all other answers are unprofessional. Answer:16 The preferred answer is (a). Discussion: This situation deals with inappropriate professional conduct from the two doctors. You have noticed that the doctors’ behaviour embarrassed the patient. It is however not your place as the nurse to say anything in way of reprimand to the doctors. Answer (a) is therefor appropriate. Answer:17 The preferred answer is (c). Discussion: It is your duty as a nurse to see to each patients needs and not to favour specific patients or family members. In a case such as this it is understandable if the mother wants special attention from her daughter, who happens to be working on the ward where she is a patient, which is why (c) is the preferred answer. Answer:18 The preferred answer is (a). Discussion: As a nurse you sometimes have to deal with patients who are not happy with the amount of time spent with them by their doctor. It is up to you to reassure the patient, discuss any further queries and to act in a professional manner towards other health professionals. It is not up to you to discuss your personal opinion or those of others with the patient. Answer:19 The preferred answer is (d). Discussion: This situation requires you to deal with the patient in a manner that does not evoke any conflict. Your priority is to ensure the patients comfort and well being, however it is also important that you uphold your colleges reputation as a professional medical practitioner. Thus the correct answer is (d).



Answer:20 The preferred answer is (d). Discussion: Itchiness caused by the narcotic pain killers given after an operation can be quite distressing to the patient and there are effective remedies to relieve it. This question deals with the issue of the nurse not being able to prescribe medication herself. Trying to help the patient quickly and effectively as in response (d) by reassuring the patient (this is important) and then contacting the doctor, is appropriate. The remainder of the responses do nothing to alleviate the patient’s distress. Choices (a), (b) and (c) do nothing to address the patients problem, while (e) is entirely inappropriate. This is a strictly timed trial test. Time allowed is 22.5 minutes. PROFESSIONAL DEVELOPMENT PRIORITISING SKILLS Question: 1 Category: Prioritising skills Scenario: You are a young general practitioner working in a coastal town. Many of your patients are holiday-makers, who use your services only when on holiday. A young man who lives on the coast and has been a patient of yours for a couple of years, makes an urgent appointment to see you. He has a severe stomach upset and requires medication. He brings with him to the consultation two of his friends, both holiday-makers who have the same symptoms of stomach upset. The two friends have no appointment to see you. You have a full list of patients, all of which have made appointments. What do you do? Choices: a) You consult the patient who has made the appointment and then tell his friends that you have a waiting room full of patients. The best you can do is to try and fit them in at the end of the day. b) As they have all come in to see you together, you say nothing about the other patients who are waiting to see you. You examine your regular patient first and then examine his friends briefly and give them each a prescription for their condition. c) You tell the patients friends to speak to the receptionist, who does all the bookings, to ask her to fit them in as soon as possible and tell them that they may have to wait a while. d) You tell the friends to see another doctor as you are really fully booked and cannot inconvenience your regular patients for patients who see you when they are on holiday. e) You tell your receptionist to tell the youngsters that they should seek help from another doctor as you are too busy. Question: 2 Category: Prioritising skills Scenario: You are a hospital physiotherapist treating a football player who has had a knee-reconstruction. You have to see this gentleman on a daily basis to put him through a schedule of routine exercises, which will aid his recovery. Every time you come to see him he has visitors from his football team who distract your patient from concentrating on his movements with loud comments and jeers. What should you do?



Choices: a) You politely ask the visitors to leave the room while you are attending to the patient. b) You politely explain to the visitors that it is obvious that the patient is distracted from his exercises while they are present and to please either wait outside or not disturb him. c) You ignore the rowdy visitors and try your best to work with your patient. d) You joke along with the man’s friends, realising that your patient is not getting the most out of his physiotherapy, but at least he is being kept in good spirits. e) You tell the patient to ask his friends to leave while you are treating him. Question: 3 Category: Prioritising skills Scenario: You are a nurse in a hospital ward. One of your patients an elderly lady has lost her glasses. She only uses them to read and is getting very bored. For some time she has been badgering the staff to find her glasses. She accosts you and asks you to also help locate them. You are extremely busy. What do you say to her? Choices: a) You tell her that you will keep your eyes open for her glasses. b) You tell her that you are extremely busy right now, but that you will keep your eyes open for her glasses. c) You tell her that you are certain that the glasses will be found in due course. d) You tell her that the staff are all very busy and that she should stop badgering them. e) You ask her why she doesn’t have a spare pair of glasses, which she could have used until the lost ones were found. Question: 4 Category: Prioritising Skills Scenario: You are a nurse working in a medical ward at night. One patient is constantly pressing his buzzer, asking for glasses of water, an extra pillow, and making other small requests. You are just about adjust the height of one end of the bed for him so that he can see the television easily, when the patient in the bed next to him starts complaining of a mild backache and asks you to arrange some pain medication. Who you attend to first and what do you say? Choices: a) Your first priority is to the man in pain and you tell the patient who makes constant

requests to be patient while you call the doctor. b) Your first priority is to the man you were attending to and you let the man with the

backache wait, as the pain is not severe. c) You explain to the patient who wanted his bed adjusted that you would like to arrange pain relief for the other patient, but that you will return to adjust his bed as soon as you can. d) You explain to the patient who wanted his bed adjusted that you would like to arrange pain relief for the other patient and that he will have to wait, as his request is obviously not that important. e) You explain to the patient who has the backache that you would like to arrange pain relief for him, but that you are already attending to the other patient and that he should wait.



Question: 5 Category: Prioritising Skills Scenario: A patient with depression comes to see you, her GP. You have diagnosed her depression some time ago and essentially she has come to get another prescription for her medication. You have a child waiting in the consulting room next door, who is in a lot of pain and who needs your attention. The lady who is with you is telling you at length about her sister who seems to be suffering from depression also. She rambles on and on and you know that you need to cut her visit short to attend to the child. What do you say to her? Choices: a) You interrupt her, excuse yourself and say that you have a very urgent case next door which requires your immediate attention. b) You interrupt her to write out her prescription, then excuse yourself and say that you have an urgent case to attend to next door. c) You interrupt her and tell her that you cannot spend more time with her as you have an urgent case to attend to. d) You listen to all her problems until she is finished and simply let the child wait. e) You ask her if she can wait for half an hour or more, as there is an urgent case you need to attend to first and that you will finish your talk with her later. Question: 6 Category: Prioritising Skills Scenario: You are a doctor working in the psychiatric ward in a public hospital. The ward has an open plan and patients often just wander about in the common area. You are about to see a patient for a planned consultation before another staff meeting. You are accosted by a patient in the corridor, who proceeds to tell you at length about a last suicide attempt. You are running late and would like to complete your sceduled consultation before the staff meeting. What do you say to this patient? Choices: a) You excuse yourself, tell the patient that you have a consultation, but promise to speak to her later. b) You listen to the patient for a short time and then excuse yourself. c) You tell her that you are in a great hurry and cannot speak with her right now. d) You mention to her that she has told you all this before and that you are in a hurry. e) You tell her that you have an appointment and then a staff meeting and have no time to listen to her story again. Question: 7 Category: Prioritising Skills Scenario: You are a busy surgeon running a clinic at a public hospital. it is already late in the afternoon and your clinic is running overtime by two or more hours. One of the patients waiting to see



you is someone you operated on a year ago. You know that this patient has travelled by bus for a couple of hours to come and see you. He still has to catch the bus back that evening, but will miss the last bus if you do not see him immediately. The man approaches you between consultations and asks if you can see him soon. Several other patients overhear his request. What do you tell him? Choices: a) You ask him to enter your treatment room and attend to him immediately. b) You tell the other patients, that this man has travelled very far to see you and cannot afford to miss his bus. You apologise to them and explain that you would like to see him next. c) You ask the man wait until it is his turn, as this is only fair, and hope that he still makes it to the bus in time. d) You lie and tell the other patients that this man is seriously ill and needs to be seen immediately. e) You tell the other patients that this man has travelled very far to see you and cannot afford to miss his bus. You explain that since this makes him more important, you will see him next. Question: 8 Category: Prioritising Skills Scenario: You are a busy nurse attending to a patient who constantly makes demands on your time for trivial things. You are about to go off on your meal-break, when this patient rings for you again. You know that if you agree to do what she wants, you may be stuck with her for your entire tea break. What do you tell her? Choices: a) You tell her that you are going on your meal-break now, but shall ask another staff member to attend to her needs. b) You tell her that this is your meal-break, but in spite of that you will quickly help her anyway. c) You find out what she needs, attend to it and then go on your meal-break. d) You tell her that you are going on your break now and that you will see her when you come back. e) You tell her that you are going on your meal-break now. Question: 9 Category: Prioritising Skill Scenario: You are a young nurse working on a ward, where the clinical nurse coordinator (CNC) is very draconian, strict and widely feared amongst the nursing staff. You are just attending to a patient, who is telling you about how she lost her husband tragically a couple of weeks ago. While the patient is tearfully relating this to you, another nurse approaches you and tells you that the CNC wants to see you in her office right NOW. What do you do? Choices: a) You immediately break off the conversation, leave the patient in her tearful state and go to see the CNC.



b) You excuse yourself and say you must go to see the CNC as she expects the nurses to “jump” when she calls. c) You calm the patient down as best you can and when she seems to be under control of her emotions again, you excuse yourself. d) You tell the other nurse to tell the CNC that your patient is obviously more important and that she will just have to wait. e) You tell the other nurse to stay with the patient and then rush off to see the CNC. Question: 10 Category: Prioritising Skills Scenario: You are a nurse working on a surgical ward. You are attending to a patient who can not walk yet, after having had recent surgery. You are helping this patient to the bathroom. As you pass by one of the beds, the occupant complains to you that she has asked to be given a bed pan and is getting very annoyed about having to wait. She wants something to be done about it right now. What do you do? Choices; a) You tell the patient waiting for the bed pan that you are quickly taking this patient to the bathroom and will then come to help her. b) You tell the patient waiting for the bed pan that you are busy with someone else. c) You ignore the patient in the bed, as you can only do one thing at a time. d) You take the first patient back to her bed and decide to get the bed pan first. e) You apologise to the patient waiting for the bed pan and quickly use the buzzer by her bed to ring for a nurse, then proceed to take the other patient to the bathroom. Question: 11 Category: Prioritising Skills Scenario: You are a nurse who has been asked to attend a meeting of all the specialist doctors, who see patients on your surgical ward. You have some statistics about patients on your ward, which you have been asked to present. You want to arrive early, so that you can read through your notes one more time. As you are about to leave for the meeting one of the patients calls you over to tell you at length about the slight discomfort he is experiencing with his urinary catheter. There is no other nurse close by. What do you say to him? Choices: a) You check to see that the catheter has not dislodged, then tell that everything seems to be OK, you are about to go to a meeting but you shall come back as soon as the meeting is finished to talk to him. b) You tell him that you are on your way to a meeting. c) You tell him that urinary catheters are invariably uncomfortable and he will just have to bear it. d) You tell him that you have no time to listen to him now, but you will send another nurse to speak to him about alleviating his discomfort. e) You decide that you will be late for the meeting and stay with the patient for as long as he wants to talk to you.



Question: 12 Category: Prioritising Skills Scenario: You are a GP running a busy city practice. Your waiting room is filled with patients and it is already late in the afternoon. A man is brought in by his friend. He is very drunk and is bleeding from a cut on his forearm. The receptionist tells you that the man’s cut is superficial and not serious, but that he is being very loud and abusive and refuses to stay in the treatment room, where he is supposed to wait for you to attend to his cut. The receptionist cannot handle the man and other patients are getting upset. What do you do? Choices: a) You tell the man to behave himself or to wait outside. b) You tell the man that unless he behaves, you are not prepared to treat him. c) You tell the man’s friend to calm him down and to see that he behaves. d) You ask the man to calm down, tell him that he needs to wait in the treatment room and that you will attend to him shortly. e) You take his friend aside and ask him to stay with the man in the treatment room and then ask the man to calm down, you will attend to him shortly. Question: 13 Category: Prioritising Skills Scenario: You are a junior doctor working on a ward that looks after mothers following their deliveries. For the past two days you have been wanting to assess a patient after her delivery. Every time you come to see her, she has family visiting her. The patient wishes to be examined in privacy, but when you ask her family to leave the room, they refuse, stating that you should come back after visiting hours are over. The patient is due to go home that day and you have no other time to see her. What do you say to the patient and her family? Choices: a) You explain to the patient that the assessment will occur now or never and that she should be firm with her family. b) You tell the patient that you cannot keep coming back and that you want her family to leave the room so you can get on with the assessment. c) You explain to the patient’s family that you need to assess her, that you have wanted to do this several times in the past two days and that it is important that you have some privacy. d) You tell the patient that the assessment is not urgent and that you might just not bother with it. e) You angrily confront the patient’s family and tell them you shall call security if they interfere with your duties again. Question: 14 Category: Prioritising skills. Scenario: You are a midwife working in a labour ward. It is the middle of the night and all other staff are busy. You are alone with two women, both in labour. One of the women has been put on a drip to facilitate labour. The other woman tells you to call the doctor, as she urgently wants to ask him something. At the same time the woman with the drip starts



shouting that she can’t stand the pain any longer and wants to change her position to get comfortable. This is difficult because of the drip in her arm and she needs help. What do you say to the ladies? Choices: a) You tell the first lady that you will call the doctor as soon as you have helped the other

lady, which will only take a minute. Then you help the woman with the drip get into a comfortable position.

b) You tell the lady with the drip that you will attend to her as soon as you have called the doctor, which will only take a minute.

c) You tell both women to stay calm and you will attend to them both in due time. d) You tell both women to calm down and then proceed to the nursing station to call the doctor. e) You ask the first lady if you can possibly answer her question. Question: 15 Category: Prioritising Skills Scenario: You are a nurse working the night shift in the psychiatric ward of a public hospital. While you are sitting in the nurse’s station one of your patients comes to you with a long story of how she woke up, to see her father standing next to her bed. He told her that she must go home right away. While you are listening to her, another patient rings the buzzer for your attention. How do you handle the situation? Choices: a) You gently tell the lady that you will escort her back to bed and then give her some medication to help her get back to sleep. b) You escort the patient back to her bed and tell her that you will be right back with some medication to help her get back to sleep. Then you attend to the other patient who rang the buzzer. c) You tell the patient that she should go back to bed and that you need to answer the buzzer. d) You tell the patient that her story is all nonsense and to go back to bed as you have to attend to the patient who rang the buzzer. e) You tell her that her story is a lot of nonsense and that she cannot go home now as it is the middle of the night. Answer:1 The preferred answer is (c). Discussion: In a medical practice, unexpected situations often arise. In this case, the two others who have come along with their friend are not really critically ill, and can afford to wait until the receptionist can fit them into the doctor’s schedule, without inconveniencing too many patients. Therefore (c) is the preferred answer. Other patients may feel unfairly treated if you see all three together as in choice (b). However you do have a duty of care to these patients, and should not have to refer them to someone else or ask them to come back unless there is absolutely no other option. Thus choices (a), (d) and (e) are not the preferred answer. Answer:2 The preferred answer is (b)



Discussion: As a health care professional the wellbeing of your patient is your first priority. In this situation the patient cannot be effectively treated, due to constant interruption from his rowdy his friends. By communicating politely with the visitors, offering an explanation to them and giving them the choice of leaving or being quiet, you will hopefully gain their cooperation. Thus the best answer is (b). Options (c) and (d) show a lack of prioritisation of your patient’s care. Answer:3 The preferred answer is (b). Discussion: This situation deals with empathy for the patient concerned. However, it also requires you to understand your duties towards all other patients under your care. It would be highly unprofessional for you to prioritise this patient’s personal needs while your other patients require medical attention. Thus the obvious choice is (b). Answer:4 The preferred answer is (c). Discussion: In this scenario the nurse has to deal with demands by two patients and must prioritise one of them. The man who has the backache will be in more discomfort than the man who needs the bed adjusted to watch television. The preferred choice (c) involves explaining to the first patient why you are leaving and that you will be back as soon as possible, before attending to the patient in pain. Answer:5 The preferred answer is (b). Discussion: Prioritising skills are important when determining where to focus immediate attention, to benefit patients under your care the most. The lady in question essentially only needs a prescription renewed, so there is no point in making her wait and to continue any further irrelevant discussion with her. The patient in serious discomfort who is waiting for your care should take priority in this situation. Thus (b) would be the most appropriate choice. Answer:6 The preferred answer is (a). Discussion: This situation needs to be handled very delicately with appropriate communication, to ensure that the patient that approached you in the corridor does not feel rejected, even though you have little time at the moment. It would be more beneficial for you to organise an appropriate time for yourself and the patient to discuss her problems. By doing so you not only prove to her that you want to help, but also prioritise your attention regarding patients. Thus the preferred choice would be (a). Answer:7 The preferred answer is (b). Discussion: In this scenario a particular patient has travelled far to see you. Answer (b) is the preferred answer, as you should give priority to this patient due to his circumstances. Your other patients have a right to an explanation however, hence answer (a) is incorrect. Choice (d) is dishonest and choice (e) is incorrect, as this person is not more important than your other patients.



Answer:8 The preferred answer is (c). Discussion: As a nurse your primary priority is to ensure the wellbeing of all patients under your care. By briefly attending to the ladies needs you are still fulfilling your duty of care towards her and are prioritising your time appropriately. The preferred option is (c), as all other choices do not encompass your duty of care towards the patient. Answer:9 The preferred answer is (c). Discussion: Your patients are your priority. Your primary duty of care should take precedence over other distractions and thus answer (c) is the preferred answer. It is inappropriate to simply leave the patient with another nurse in this situation as in option (d). Option (d) is not professionally appropriate. Answer:10 The preferred answer is (e). Discussion: Often a situation might arise where your care is needed in two places simultaneously. Since you are accompanying a patient to the bathroom, it would be highly unprofessional to abandon her immediate needs for the patient making the complaint. Thus it is preferable to call for another nurse to help you. Thus the most appropriate answer is (e). Answer:11 The preferred answer is (a). Discussion: Any complaint by a patient, however trivial, should not go uninvestigated. Catheters, tubes and drips often cause discomfort and may also become dislodged. By quickly checking that everything is in order, the nurse is not late for her appointment and can further reassure the patient later on. Therefore (a) is the preferred answer. Answer:12 The preferred answer is (e). Discussion: As a healthcare professional your duty of care is towards every individual patient. One patient should not be allowed to disrupt and disturb the smooth running of a practise through bad behaviour, which is why (e) is the preferred answer. Answer:13 The preferred answer is (c). Discussion: As a health care worker you prime responsibility is to care for your patients. If family is hindering you from carrying out your duty it is up to you to make this clear in a friendly but firm manner, which is why (c) is the preferred answer. Answer (d) is medically negligent and answer (e) is rude and inappropriate. Answer:14 The preferred answer is (a).



Discussion: In this scenario it is necessary to prioritise the patient’s requests. The lady with the drip, who is in discomfort, is your first priority, but the other lady should also be reassured that you will call the doctor as soon as possible. Thus choice (a) is preferred. Choice (c) doesn’t involve any action being taken at all, while choice (e) does nothing to help the lady in pain. Answer:15 The preferred answer is (b). Discussion: As a health care worker your responsibility is towards all your patients. Here you have a situation where two patients are demanding your attention at the same time. Answer (b) is the preferred answer, as the needs of both patients are attended to. Answer (a) does not deal with the patient ringing the buzzer, while choices (d) and (e) are professionally inappropriate. TERMS OF ACCESS You are permitted access to the materials contained on this site upon the following terms and conditions: This site is created and maintained by Dallas Gibson of Tertiary Prep Skills, Australia referred to as “We”, “us” and other relevant parts of speech. By proceeding further to access any part of this site, you agree with us: GENERAL The services displayed on this Site are available for purchase only by those individuals over 18 and who have full capacity to enter binding contracts on their own behalf or on behalf of those individuals under 18 for whom they have legal responsibility. You must not transmit or attempt to transmit any material of any kind to this Site which contains a virus, malicious computer code which is or is likely to be destructive of data or programming or other harmful component. You must not otherwise attempt to alter any of the content on this Site. You acknowledge and consent to the disclosure by us to any law enforcement agency or government authority authorised to compel production of such information under Australian law that is investigating any breach or suspected breach of any law in any jurisdiction of your identity or other information provided by you to this Site, upon being requested to do so by that law enforcement agency. TERMINATION We reserve the right to withdraw any offer we have made to you to purchase services from this the Site at any time without notice. All rights and remedies of either party accrued at the time of termination and all disclaimers and limitations of liability will survive termination. Should you object to any of these Terms and Conditions (including any



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